HomeMy WebLinkAboutPermit Mechanical 1994-7-28
RESIDENTIAL
PERMIT APPLICATION
.
SPRINGFIELD ....,
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSER '?'.!2HK: ",f.iPQ._
ASSESSORS MAP' \' 1 U~ C\ ~"'36
LOT'
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..
.
~!V~'5<\
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
(,...Av
Tlx LOT: ffi ~cCi )
BLOCK:
SUBDIVISION'
OWNER: ("('1"'.11'0 ~'1I'v:\
ADDRESS-' -tJ 12. \-\~vrkn br\J:ti
- I l U
CITy:~...LJl
~I
STAT~'
(')r
DESCRIBE WORK: 1:.~iiJ,llj
NEW REMODEL+
(k~ -hLm.i;' Ir(p( Aft__
I I
ADDITION DEMOLISH
CONTRACTOR'S NAME
CENERAI.
PLUMBING:
MECHANICAL:
(-kr~tfr)
ELECTRICAl'
QUAD AREA: ~~
. OF BLDGS:
OCCY GROUP'
" OF STORIES:
WATER HEATER-
OTHER
PHONE:
7'1 h37q1
ZIP: 17y77
ADDRESS
CONST,
CONTRACTOR'
EXPI RES
PHONE
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
D Rough Electrical - Prior to
cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
'r . . .., ," ..- . ."
D Fireplace - P~jor to -ja~'lng
materials and Imming Insp.
D Framing - Prior to cover.
o Wall/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
o
Wood Slove - After installation.
'a(]]
W Sf"'.-Ll L.
* 76 5lt'1
34lf-]<t8/
- OFFICE USE -
LAND USE:
. OF UNITS-
CONSTR. TYPE:
HEAT SOURCE:
RANGE:
FLOOD PLAIN:
ZONING CODE: _
. OF BDRMS'
SECONDARY HEAT-
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.
D Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
D
Underslab Plumbing' ElectricalJ
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 10 insulation or dockin'J.
D
Post and Beam - Prior to floor
Insulation or decking.
D Floor Insulation - Prior to
decking.
D Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior to filling
trench.
D Wat~r Llne.- Prior to t!lPng
trench.
D Rough Plumblng - Prior te:
cover.
o Insett'- After fireplace approval
and installaiion of unit.
o Curbcut to. A.pproach - After
form!: are f~rec!cd but prior to
p:acer:lC!lt Of r.oncretc.
D
Sidewalk &. :Jd'Jew3Y - Afte,
cxcovatior. i: comptele, forms
Clnn s~b.basc material in place.
fJ i=,:?;lce - Vlr..;.n ~orr.pt:}',"'ld.
;-----.1 .$t;'-aet Tree,; - Wl~.:;-~ ;~ll rC~luired
. '
~ ~rces are :::1:1t'lf(:d.
D Final Plumbing - When all
plumbing work is complete.
o Final Electrical - When all
electrical 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.
~ Other eQ.(f, h ~ ~
.J.Ak
MOBILE HOME INSPECTIONS
r-l Blocking and Set.Up - When all
blocking Is complele.
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.
r -.l Final - After all required
... Inspections are approved and
perches, Skirting, decks, and
VCntl;1g have been installed.
Lot faces
Lot Type .
Lot sq, ltg,
Lot coverage
Topography
Total height
Inlerior
Corner
PQn~and~c
CuI-de-sac
BUILDING PERMIT
ITEM SO. FT, X $/SO, FT,
Main
Garage
Carport
Total Val ue
Building Permit Fee
Stale Surcharge
Total Fee
(A)
, ~THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
ond approved by the Hislorical
Co:.rdinator prior :0 p.,?rmit j;'jsu<::.ncc.
Selback,;
r-;;;::-T;:;SE I GA; ACZ
IN
~-I---,--
, I
:1 j_I== ~~-=
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
VALUE
SYSTEMS DEVELOPMENT CHARGE (SDC)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT.
Water
FT.
Storm Sewer
FT.
Mobile Home
(
Plumbing Permit
State Surcharge
..,../"
Total Cllarge /' (C)
/"
MECHANICAL PERMIT
/
Furnace
/~st Hood
/vent Fan NO
Wood Stovellnsertl Fireplace Unit
Dryer Vent
Mechanical Permit
(6)
FEE
~
\
ISsP /
-in .cp
AS ~ - lt2
2J.d'1()
\ Issuance
~te Surcharge
T"'.tal,Permit (D)
" "- ~
MISCELLf.NEOUS PERM!TS-
Mobile Home .~~-: --
State Issuance
State Surcharge
Sidewalk
lt
Curbcut
lt
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, 6, C, 0, and E Combined)
aID.?O
APPROVED:
This permit is granted ~m the express condition that the said
construction sllall, ill all respects, conform to the Ordinance
adopteJ by ttw 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 Fcc:
Date Paid:
Receipt Number'
Received By:
Plans Reviewed By
Date
SYS:Cill~~ Devclopnwnl Ctw10e is (iuc on all undoveloped
properties wittlin 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 lhat all
\ information hereon is true and correct, and I further certify
1 that any and all work performed shall be done in accordance
I with the Ordinances of the City or Springfield, and the Laws
! of the Slate of Orc~Jon 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 ttlal only contractors and employees who
arc in compliance willl ORS 701.055 will be used on this
project.
I further agree to ensure that all required inspections are
requested at the proper lime, that each address is readable
!ro;n Ih:- stre~t, thaI Ihr:- r~rmit Gard 1s 10r:-atcd.l11 Ihe front
of the property, and the approved set of plans will remain
on the site at all times during construction.
Signature ~ M.A+t.1.
Date tJ7-~ - qlf
VALIDATION: \^ 'N"\(t
RECEIPT NUMBER ~\M"\
DATE PAID f ) "r\CAq~
AMOUNT f1ECE~D ~
RECEIVED BY ~.t:0- '