HomeMy WebLinkAboutPermit Building 1999-1-11 (2)
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RESIDENTIAL
PERMIT APPLICATION
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Inspections: 726-3769
Office: 726.3759
LOCATION OF PROPOSED WORK: ~r[ J
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ASSESSORS MAP'
LOT'
OWNER' /!1fL 4c~ E!"IAJ
ADDRE~"" ';;72-'7 mt:fnu
CITY' S,tJlZ/#i h8//
DESCRIBE WORt<.
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NEW
REMODEL
CONTRACTOR'S NAME
Fe1JUvH
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SPRINGFIELD
BLOCK:
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STATE: ;J 12 e r r-7r">-..
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ADDITION
DEMOLISH
OTHER
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.
JOB NUMBER
qfO O? 1- - 4-
225 Fifth Street
Springfield. Oregon 97477
TAX LOT'
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SUBDIVISION:
PHON~'
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ZIP:
~?Cf'7 ,5
ADDRESS
t:- -,:tJ(IR-iS
CONST.
CONTRACTOR'
EXPIRES ,~ PHONE
FLOOD PLAIN:
t-lU'l'\\'
-. ZONING l'\eEfE~\'I\: _,,~
N01\lit:.. s"('l~'dr:e"'r'\ r-P,w.\' \5 \W .
S I''(:.",w.\' ,,\n'C.?s..~"\I"G \'u'"
,\'1\ "'\2.'2.0 \lSECO~OI'iR;(,CREAT:
0'\'\\)1' /"'II'>. \S "." ' .
r>:C",,\ct:\) SQUARE FOOTAGE:
('(\W\I-I\;;' _ , o~l'\\t IV,
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To request an Inspection, you must call 726-3769. This Is a 24 hour recordlng~e.:"1nspectlons requested before 7:00 a,m, will be
made the same working day. Inspections requested after 7:00 a,ffi. will be made the following work day,
GENERA' .
PLUMBIN(>'
MECHANICAl'
ELECTRICAl'
'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 are
excavated.
D Masonry - Steel location.. bond
beams, grouting. .
D Foundation - After forms are
erected but prior .to concrete
placement,
D Underground Plumbing - Prior
to filling trench,
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Post and. Beam - Prior to floor
Insulation or decking.
~Vl loor Insulation - Prior to
decKlng,'.J ~
, c.~~G A.v\.-
D Sanitary Sewer - Prior to filling
trench. '
D Storm Sewer - Prior to filling
trench.
D Water Line - Prior to filling
trench.
D Rough Plumbi~g - Prior to
cover,
- OFFICE USE -
LAND USE: _
. OF UNITS'
CONSTA. TYPE:
HEAT SOURCE:
RANGE: _
~UIRED INSPECTIONS
, ~. ~h Mechanical - Prior to
ver,
~~/.~~ Electrical - Prior to
~~r.
, D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
ail/Ceiling Insulatlor:' - Prior to
ver,
wall - Prior to taping,
D Wood Stovo - After Installation.
D Insert - After fireplace approval
and Installation of unit.
'D Curbcut & Approach - After
forms are erected but prior to
placemont of concrete,
D Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place,
D Fence - "\then cOf'lpleted.
D Street Trees - When all reQuired
trees are planted:
al Building - When all
r ulred Inspections have been
approved and building Is
completed.
DOther
MOBILE HOME INSPECTIONS
D Blocking end Set-Up - When all
blocKing Is complete,
D PlumbIng 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
venting have been Installed.
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SYSTEMS DEVELOPMENT CHARGE (SDC)
Lot 'aotl
~t~.
Lot sq. ltg,
Interior
Lot coverage
Corne r
Panhandle i
Topography
Total height
Cul.de.sac
BUILDING PERJt1JIT "I
ITEM sa, FT.
';; .,t
X s/so. FT. =
Main
Garage
Carport
F7A1fs j. /?A/rQo.6Vr
Total Val ue
Building Permit Fee
State Surcharge
Total Fee
(A)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanitary S~wer
Water
FT,
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/Insert/Fireplace Unit
Dryer Vent
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(,<..o",/:, I4je~
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
et:uoTA?~,/
Total Miscellaneous Permlls
(E)
PL.
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S
I
~T
VALUE
'.
FEE
1).00
10, c)u
<{>:'. 7)'
2 C. Z-tJ
12 ( 1.
r' /- "lJ-
TOTAL AMOUNT DUE (excluding electrical)..-'" -'-
(A. B, C, D. and E Combined) 2' ~ J. ro
it,.: ~ /\~
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.~IS THE PROPOSED WORK tN 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.
Setbaoks
HSEIGAR
Accl
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BUILDING W\LUE, PLAN CHECK
AND BUILDING PERMIT
APPROVED'
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.
7(.~;
Plan Check Fee'
Date Paid:
Receipt Numbe'"
Rec;;!JBtJ~
,/lf7
I Date
Plans Reviewed By
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS ,
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Note:
Building Inspector may require
additional plans information,
andlor fees for the comp:etion of
this project
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 at of plans will remain
;n the Site~at all1 H~ dur'JO: nstrucHon,
Signature fiJ~ (1/? t
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Date ;/1(.97
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
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1/11/5''7 .
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RECEIVED BY