HomeMy WebLinkAboutPermit Building 1991-8-15
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R~SIl:i~TIAL
PERMIT APPLICATION
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Inspections: 726.3769
Office: 726.3759
LOCATION OF PROP~3Pror~i t)fq\y{ - \j
ASS~SSORSMAP:.,. \ IlJutj' l\ ~.
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JOB NUMBER
225 Fifth Street
TAX LOT'
LOT: 'BLOCK' SUBDIVISION'
OWNE(~l1lfL llJnfl(!1.L n~ PHON~' 1')4 \ -L\'\~<r1
A6DRE::Yh \~ ~~~r:cA .' , If t 1
CITY Y.-\. JO.R J\.Q j STATE: ----1d>) J\ 01\1 Fh\ ZIP: q ~) ~ .J
'IJ -' (
DESCRIBE WORK' '-..'1J'N\ ~ j\ 0 t.P ) b, t="'. ~ J::'l \ ;~
NEW V REMODEL A1DITION DEMOLISH OTHER
I /'"
CONTRACT<('\S N~ ,,0 1
GENERAl' LA. 1 ] \U.f--/
PLUMBING"
MECHANICA' .
ELECTRICAL'
".
ADDRESS
CON ST.
CONTRACTOR'
PHONE
'EXPIRES'
- OFFICE USE -
'RtD\~ ') -, \ \ \ \
QUAD AREA: LAND USE: FLOOD PLAIN'
. OF BLDGS: \ . OF UNITS' \ ZONING CODE: t...1J\U
OCCY GROUP: \??V~" tv\ CONSTR. TYPE: VN . OF BDRMS: '~
J::J , ~P...
. OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: t?~ RANGE: r. 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.
~mporary Electric
G Site Inspection - To be made
.. after excavation, but prior to
, setting forms.
CJ
Underslab, Plumbingl Electricall
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
:1
o Masonry - Steel rocatlon, bond
beams, grouting.
o Foundation - After forms are
. , erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench,
II . . .
~nderfloor Plumbing/Mechanical
~ :. Prior to insulation or decking.
~, Post and.'Beam - Prior to floor
~;nsulatlon or decking.
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1.><1 t-Ioor Insulation - Prior to
~decklng.
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench.
o Water Line - Prior to filling
, trench.
lVI"RoU9h Plumbing - Prior to
~over.
REQUIRED INSPECTIONS
~ough Mechanical - Prior to
~over.
~Rough Electrical - Prior, to
~ ~over.
~Iectrical Service - Must be
~ ;pproved to obtain permanent
~Ie~trlcal power.
o Fireplace - Prior to facing
materials and framing Insp.
~ming - Prior to cover.
~all/ceiling Insulation - Prior to
~~:'ver. .
~ryWall ,- Prior to taping,
o Wood St~ve - Aft~~ Installatlo~.
o Insert - Afte.r fireplace approval
- and Installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
. 0 Fence - Whe,n completed.
rn Street 1rees - When all reQUlrE!d
trees are planted. .
~nal Plumbing - When all
~piumblng work Is complete.
r
IYI~t-inal Electrical - When all
~ electrical work I~ complete.
/'
D<1 t-inal Mechanical - When all
~mechanlcal work Is complete.
-~nal Building - When all
~~qulred Inspections have been
approved and building Is
completed.
o Other
MOBILE HOME INSPECTIONS
'.
o 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
_ - Inspectlo'ns are approved and'
" porche.s,. skirting, decks, and
venting have. been Installed.
~
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d
Lot faces Lot Type Setbacks IS THE PROPOSED WORK I~THE "
Lot sq. Itg. 'f;Jl-Oi. ~nterior I P.L. HSE GAR ACC I HISTORICAL DISTRICT, OR ON
IN /'1' I THE HiSTORICAL REGISTER?
Lot coverage ~ _ Corner If yes, this application must be signed' "
Is ((/ I and approved by the HistoricaL
Topography hi Panhandle Iw /f/ I Coordinator prior to permit issuance~"
Total height Cul.de.sac IE ( I
,10, APPROVED: ,
"
BUILDING PERMIT
sa. FT.
/;;(75
5BcJ
X $/so. FT.
VALUE
ITEM
Main
Garage
Carport
Total Value
cq~~
S< $f:.~o
I '1-. ~
,'1,00 -~I?
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC) ,
~ 1c.F-\9~ ~
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
N' "7
Residential Bath(s) IX
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
/6~.OO
. ;
Mobile Home
<Cf{(=-i)1 r- J'os#Ef'crO>&fl>
75.00
~q &0
4-,7--5
e 'f.At;
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
{{:. t!)O
4.5'0
(0 ,~o
Fu mace
Exhaust Hood
Vent Fan
N'
:J..
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
s,60
Mechanical Permit
/q,5'O
I A) .&0
/,if (j
30m3
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E) I.
TOTAL AMO~NT DUE (excluding electrlcatt! 7,) /J< (!), '5'(
(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 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 A said ordinances.
Plan Check Fee' .J R~ .'-\('')
Date Paid: ~. ;'.;. q I
Receipt Number:--.::: ffi/ I.!::I-
Re~eiv By: . IM~)
~//)/lR ,
Pl: S Re;;;~~6 iy-
a.h~h '"'
~;
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
\..l1J\.lf\r\{)hc"J1) (~~
lY 1 f\n 0 r (\rtJ ~ Aq()~0S
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 I n 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 siteRall times during constructCYl
\/':tature ~ '1rr1,......., -' J2. y\ J... "'.~._ ,I ~
I:ate 'X - /<) ~ q I
VALIDATION: _ II :::::>
RECEIPT NUMI}.ER CJ( \ ()~ )
DATE PAID cA\.'J() \ ~ \~ctT
AMOUNT REC~IVEO ~\, fl'\ Il CY S1
RECEIVED B~ <:7\(,L)O )
.... .it
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Permit No: 9 \ffiCb ~ '"
Add,,,, &m- \) Ctn.l Vf11 U
,Issued b : 0 _ ') Date: R.IS .q J
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:,
1. ~' I own, reside in, or will reside in the completed structure.
2. ~ L-.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 ao hire a !;leneral
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.
,_Pf, ~..~,o~{2~~
Signature of Permit Applicant
X'-J<::~?/
Date
"
'-"!
CONSTRUCTION CONTRACTORS BOARD
0244J 10/24/89
~ PY TO ISSUING AGENCY PERMIT FILE
\,~g,y TO APPLICANT"
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