HomeMy WebLinkAboutPermit Mechanical 1995-2-13
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RESIDENTIAL -.
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
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JOB NUMBER
225 Fifth Street (15"'0/77
Springfield, Oregon 97477
ASSESSORS MAP'
LOCATION OF PROPOSED WORK' f I.{ lS' \-10...,.1 ~.... 13 { t d,."J-e. (..J. \
IIO~7C:22-ci[Y707
LOT'
----
BLOCK:
OWNER:
ADDRESS:
CITY'
e.n b of- (LebecCCf
I' 2.1 'L La (.\1\. ~
S P (,"":.9 ~ ~_U,
W~HC ~
Looo
STAT~' '
OY<-
TAX LOT:
SUBDIVISION'
PHONE: l!f...l.. -" 701 (
ZIP:
q l....rL,/
DESCRIBE WORK: ~II
o~ .r N ..~},.t ~l!l~ Fur "'de-e
NEW
REMODEL
PHONE
CONTRACTOR'S NAME
GENERAl'
PLUMBING'
MECHANICAl'
ELECTRICAl'
\'Y\tl ,,, k4 \ \!..r
QUAD AREA'
· OF BLDGS:
OCCY GROUP:
· OF STORIES:
WATER HEATER:
ADDITION
DEMOLISH
OTHER
ADDRESS
CONST.
CONTRACTOR'
o Rough Mechanical ~ Prior to
cover.
D Rough Electrical - Prior to
cover.
o Electrlca' Service - Must be
approved to obtain permanent
electrical power,
o Fireplace - Prior to facfng
materials and framing Insp.
o Framing - Prior to cover.
i
o Wall/C'elllng InSOlation - Prior to
cover.
o Drywall - Prior to taping,
o Wood Stovo - A.fter Installation.
o Insert - After 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.
o Fence - When completed.
o Street Trees - When all required
trees are planted. .
EXPIRES
"E I, sic-<: d-
"2.S'" 7 q 6
'"l.-jU/H
-:......\.
S 9 WJ. ,eft l( lit
I q )-1'1l.fJ
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 aller 7:00 a,m, will be made the following work day,
REQUIRED INSPECTIONS
t-I e...tl'_j
l.f(31
Ceo
o Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
o Footing - Aller trenches are
excavated. ~
o Masonry - Steel location, bond
,beams. grouting.
o Foundatfon - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench,
O Underlloor Plumbing/Mechanical
- Prior to Insulation or decking,
o Post and Beam - Prior to floor
Insulation or decking,
"
O Floor Insulation - Prior to
decking.
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench.
o Water Une - Prior to filling
trench.
o Rough Plumbing - Prior to
cover.
- OFFICE USE -
LAND USF'
· OF UNIT~'
CONSTR, TYPE:
HEAT SOURCE:
RANG~'
o Final Plumbing - When all
plumbIng work Is complete.
. .
D Final Electrical - w.hen all
electrical work Is com-plele. C
o Final Mechanical - When all
mechanical work Is complete.
o FInal Building - When all
required Inspections have been
approved and building Is
completed.
o Other
MbBILE HOME INSPECTIONS
o Blocking snd Set, Up - Whefl all
blocking Is complete,
o Plumbing Connecttons - When
home has been connected to
water and sewer.
o Electrical Connection - When
blocking, sel.up, and plul1lblng
Inspections have been approved
and the home Is connected to
the service panel.
o Final - After all required
Inspections are approved and
porches, sklrtlng, decks, and
venting have been Installed.
Lot faces
"t,\
Lot sq, Ilg, '
LOI Type..
InterIor
Lot coverage
Corner
Topography
Total ljelght
Panhandle
Cul.de.sac
. .~.
I.
I P.L.
IN
Is
W
E
BUILDING PERMIT
ITEM SQ, FT, X $/SQ, FT, a VALUE
f\1aln
Gacage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Feo
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
.
Residential Bath(s) N'
Sanitary Sewer FT,
.. Water FT,
Storm Sewer FT,
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
~HANICAL PERMIT
/Furnac~J
" ' I
C.XllaU..~ Hood
"
FEE
~\'\V' It) i)O
Vent Fan
N'
Wood Stovellnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuahce
State :Surcharge
Total Permit
(0)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demoiltlon
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, e, C. 0, and E Combined)
Is.a)
-to ,flU
.7h
,0..1'1
:, ~
V\v.V'
.' .; ; ....li. ~I: .:\f:~?
Setbacks.
HSE GAR ACC' I
'.S THE PROPOSED WORK,tN THE. '
'''HISTORICAL DISTRICT, OR ON
"THE HISTORICAL REGISTER?
" yes, this appilcatlon must be signed
and approved by the Historical
Coordinator prior to permit Issuance..
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condition that the said
construction shail, In ail 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.
Plan Check Fee:
Date Paid:
Receipt Number
Received By:
Plans Rovlewed By
Date
Systems Development Charge Is due on all undeveloped
properties within the Clly limits which are being Improved,
ADDITIONAL COMMENTS
\f.'1 ~ 4 -L
-if 52SSll0
By signature. I state and agree, that I have carefuily 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
01 the State of Oregon pertaining to tho work described
herein, and thai NO OCCUPANCY will be made of any
structure without permission 01 the Building Salety Division,
I further certHy that only contractors and employees who
are In compilance with ORS 701.055 wlil 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 site at all times during construction.
Signature k:2L~
Date 2. - t~ - "i-)
VALIDATION:
RECEIPT NUMBER \ 1.0 z '6 S
DATE PAID 2-/7,~qS
AMOUNT RECEIVED 2 {p . 2..-0
tV.__
RECEIVED BY,
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