HomeMy WebLinkAboutPermit Building 1998-7-13
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726,3769
Office: 726,3759
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ASSESSORS MAP'
LOCATION OF PROPOSED WORK: .S-<!OJ
/7 () Z2-?;t(s
LOT'
BLOCK:
OWNER: ~CeJryc.
ADDRESS:' <;"..S-
CITY: ,"" /'" .I),
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DESCRIBE WORK' fr'0D
NEW
REMODEL
CONTRACTOR'S NAME
GENERAl'
PLUMBING'
MECHANICA' .
ELECTRICAl'
OUAD AREA-
. OF BLDGS:
OCCY GROUP:
. OF STORIES:
WATER HEATER:
STAT'"
O(
.
JOB NUMBER
CfrO'lLf /
/zJ; L-~r !}.
225 Filth Street
Springfield, Oregon 97477
TAX LOT:
SUBDIVISION'
170 f"o 0
PHONF'
?Z(; ~ tf'?J'X (..)-.....)
ZIP:
f/e../~cf:
To
f"r,'srIWq.
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover. . .
D Rough Electrical - Prior to
cover.
D Electrical Service - Must be
approved to obtai n permanent
electrical power.
D Fireplace - Prior to facing
~materlalS and framing Insp.
raming - Prior to cover.
6 c~~~/r~efling Insulation - Prior to
~wall - Prior to taping.
D Wood Stovo - After Installation.
D Insert - Atter fIreplace approvel
and installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sidewalk & Driveway - After
excavation Is complele, forms
and sub-base material In place.
D Fence - When cOi"-lpletcd.
D Street Trees - When all required
trees are planted.
EXPIRES ,,,, PHONE
,-
FLOOD PLAIN'
ZONING CODE:_
. OF BDRMS:
SECONDARY HEAT:
SOUARE 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, Inspectlons requested after 7:00 a.m. will be made the following work day.
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ADDITION
DEMOLISH
OTHER
D Temporary Electric
D Site Inspection - To be made
after excavatIon, but prior to
setting forms.
D Underslab PlumblngJElectrlcalJ
Mechanical - PrIor to cover.
D Footing - After trenches are
excavated. .
D Masonry - Steel locatlon,"bond
beams, grouting.
D Foundation - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
hto fllllng trench.
, ;
. D/~nderfloor Plumbing/Mechanical
l./ - Prior to Insulation or decking.
D Post and Beam - Prior to floor
insulation or decking.
D Floor Insulation - Prior to
deckl ng.
D Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior to filling
trench.
D Water Line - PrIor to fllring
trench.
tE]\OU9h Plumbing - Prior to
~'over.
ADDRESS
CONST.
CONTRACTOR'
~!~T'~'?'
THIS PERMIT SH~Et\9{PIHl!'IF-THE WORK
AUTt\OfII.2W'I3t'nC:1:l nu~ PERMIT IS NOT
COMMe~aHD~ANOONEDFOR
ANY~!W13M.~D,
HEAT SOURCE:
RANGE: __
(9)
F 81 Plumbing - When all
D '.umblng w9rk Is complet.e.
D Final Electrical - When all
electrical work Is complete.
D Final Mechanical - When all
mechanical work Is complete.
~FI al BUilding - When all
r uired Inspections have been
pproved and building is
completed.
DOther
MOBILE HOME INSPECTIONS
D Blocking and Sel'Up - When ail
blocking Is complete.
D Plumbing Connections - When
home has been connected to
water and sewer.
D Electrical Connection - When
blocking, set-up, and plumbing
Inspecllons have been approved
and the home Is connected to
the service panel.
D Final - After all required
Inspections are approved and
porches, sklrllng, decks, and
ventlng have been Installed.
'. , ",
Lot faces Lot Type
Lot sq. fig. Interior I PL.
IN
Lot coverage Corner
Topography Panhandle ,. Is
Iw
Total height Cul.de.sac
IE
BUILDING PERMIT 'I, " '1
.1!
ITEM sa. FT. x $/SO. FT. VALUE
Main
Garage "
Carport
~ fwo (,VJ(,.1Io / POD
I
Total Value
Building Permit Fee / J,'>-O
State Surcharge ;,4/
Total Fee (A) jrt,1/
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
,f :FEE
;. 2:-0
FIxtures
2
Residential Bath(s)
N'
Sanitary S~wer
Water
FT.
Storm Sewer
FT.
FT.
Mobile Home
Plumbing Permit
j, /JiI It.1J'
I
State Surcharge
Total Charge
'1-/.&0
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsert/Flreplace Unll
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcul
It
Demolition
State Surcharge
M S()t
/
Total Miscellaneous Permits (E)
~t.f 7.. I{q
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
;;'....
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,.
Setbacks.
HSE GAR ACC'
,.
I IS THE PROPOSED WORK IN THE.
'HISTOI;lICAL DISTRICT, OR ON
THE HISTORiCAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
APPROVED:
. ..,..... 'I
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
oulldlngs, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plan Check Fee:
[I. '1 'I
Date Paid:
Receipt Number'
Received By:
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties within tho City limits which are being improved.
ADDITIONAL COMMENTS
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By signature, I state and agree, that I have carofully examined
the completed application and do hereby certlfy that all
Informatlon 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 perlalnlng to the work described
herein, and that NO OCCUPANCY will be made of any
structure without permission of Ihe Building Safety Division.
I further certify that only' contractors and employees who
are In compllancc 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 pcrmlt 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.
Signature
Date
VALIDATION:
?,Di0&
DATE PAID 1/::" I? -lj ~
AMOUNT RECEIVED ----.iI: c).p/q, :!> <i;
~
RECEIPT NUMBER
RECEIVED BY
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SALES SLIP
Cu,tome', .98'0 5r4( Phone 7'''''/ 07? r-- ,/
Order N~ v I No. ~- 0 .")...> Dote.2! {1
Sold T~ .~iLAt. F. - .,J. AL.
Addre,< 540 ~ ;l(6-f{~~W~ J!.O
(IO~D IT
I Quontity
')(1 C. 0, D. I CHARGI I ON ACC',
, DESCRIPTION
I M.st. lIT.. I ,.,. OUT I
PRICE AMOUNT
19 fg'
17 SO
/ 'II
'ZCJ ~
I ?
Ii,. I I/; ;Vj 11; It m , Lib
q,A~A-J.sf.., AJ~,,... t!.o. 570
f/!,A",h,('1: ~11.""'_-,../ K<
" Al tr0 AI r' r'
<:;,../'J..- / /" f~;n./^" I-~ /0
(i ~i<- ~/) (-
fJ!w.! /!; t//6k/ ~
SANI'1Ih2.-v. YWu
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!~i''''' l~,':'
,
. II 15~ I
i2~)' ""/' () I
1/ 79
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~ o,.<jOTAL 2.<7 g
199'0 gOgmS ond ret::::d ::Od'1S~;~:~'() nled by thIS bill.
TAX
. ~ PRODUCT OF WILSON JONES, U.S.A.
CARBON lESS PAPER
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FORM 50-581
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City of Springfield
225 Fifth Street
Spr'ingfield, OR 97<\77
(503) 72&-3753
Tr-ansact ion l"lIJnlber 030756
July i3, i998 2:5& PM
Received fr'o,,: GEORGE HUMPHREY
:Contr~ct/O~n : FOR 5<\05 HIGHBANKS RD
Address: 5<\05 HIGHBANKS RD
City: SPR St,: OR Zip: 97<\78
-Building-
Job t: 98084-1
Description
BIJUding
St~te Sur'ch~rg"
37. Admin Fee
Plumbing
St.~te SIJr'ch~r'ge
3. Admin Fee
. Pl~n Check/Res
SDC/S~ni t~r'y Se~er's
SDClAdmin
Tot.~l:
Amt, Received:
Th~nk you, N~ncy M.
Fee 1
1.7.50
.88
w53
20.00
LOO
.<'0
1 L 38
235. j'O
11.79
299.38
299.38 C~sh
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