HomeMy WebLinkAboutPermit Plumbing 1994-2-17
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DESCRIBE WORK' _~~~
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOT:
OWNER:
ADDRESS:
CITY'
NEW
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERAl'
PLUMBING: /C)~~,
MECHANICAl'
ELECTRICAl.
.
SPRINGFIELD
.
JOB NUMBER q'?~8<2
225 Fifth Street
Springfield, Oregon 97477
SUBDIVISION'
PHONF'
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BLOCI<"
STATF'
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ZIP' C3;:>Y!/?
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ADDRESS
CON ST.
CONTRACTOR'
PHONE
REQUIRED INSPECTIONS
D Rough Mechanlcal~- ~rlor to
cover.
D Rough Electrical - PrIor to
cover.
D Electrical Service - Must be
approved to obtaIn permanent
electrIcal power.
D
Fireplace - Prior to facl ng
materials and framln9 Insp.
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EXPIRES
- OFFICE USE -
QUAD AREA: LAND USE: FLOOD PLAIN:
. OF BLDGS: . OF UNITS' ZONING CODE:
OCCY GROUP' CONSTR. T)'PE: . OF BDRMS'
. OF STORIES: HEAT SOUBCE: SECONOARY HEAT'
WATER HEATER' RANGF' SQUARE FOOTAGE:
DEMOLISH
OTHER
To request an Inspection, you must call 726.3769, This Is a 24 hour recording. All Inspections requested before 7:0D a,m, will be
made the same working day, Inspections requested after 7:00 a.m. will be made the following work day.
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 ?~ decking.
D Floor Insulation - P~lor to '
decki ng.
D
Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior to filling
trench.
D
Water Line - PrIor to filling
trench.
D Rough Plumbing - Prior to
cover.
o
D
Framing - Prior to cover.
D Wall/e'eiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
D Wood Stove - After installation.
D Insert - After fireplace approval
and Installation of unit.
"
"D~Curbcut & Approach - After
forms are erected but prior to
, placement of concrete.
D Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material in place.
D Fence - When completed.
D Street Trees - When 'all required
trees are planted.
D
Final Plumbing - When all
plumbing work is complet,e.
D Final Electrical - When all
eiectrlcal work Is complete.
D Final Mechanical - When all
mechanical work Is complete.
D Final Building - When all
required Inspections have been
approved and building is
completed,
DOther
MOBILE HOME INSPECTIONS
D Blocking and 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
ventlng have been installed.
Lot faces Lot Type.
Lot sq, Itg.' Interior I PL.
IN
Lot coverage Corner Is
Topography Panhandle Iw
Total hel ght Cul-de-sac IE
BUILDING PERMIT
ITEM SO. FT. X $/SO, FT.
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT.
FT. < --S-6- /'
Water
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsertlFireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
eS THE PROPOSED WORK IN THE
"'HISTORiCAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
Setbacks
HSE GAR ACC
VALUE
FEE
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'2:<). -
/ . ::2'$"'
76. '2.'S'"
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 S'prlngfleld. Including the
Development Code, regulating'the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provis'ions 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
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
::o~::"f~?Z:OO 7"7i~ ,
.2 'Ia" '
Date ~
I
VALIDATION:
//"76'7'
2-/7~97'
AMOUNT RECEIVEr> ~- 25-
./"i/~
RECEIPT NUMBER
DATE PAIr>
RECEIVED BY
.
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