HomeMy WebLinkAboutPermit Building 1991-9-3
RESIDENTIAL
PERMIT APPLICATION
..
Inspections: 726.3769
Office: 726.3759 '
SPRINGFIELD
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JOB NUMBER
225 Fifth Street
Sprin9fleld, Oregon 97477
LOCATION OF PROPOSED WOAl(' "5g80 #,4 ."7?~d/ /57y, 3'z>
ASSESSORSMAP: /7-0"2 ~M- VI' TAX LOT: oa~
LOT'
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DESCRIBE WORK' E./4L'L~~
NEW REMODEL.x. ADDITION
OWNER:
ADDRES'"
CITY'
CONTRACTOR'S NAME
/? w/'Y?~A"
GENERA' .
~ . ;.
pLUMBING'
MECHANICA' '
ELECTRICAl' tfl'-I.
QUAD AREA:
S '-R1\J ('
. OF BLDGS:
OCCY GROUP'
. OF STORIES:
WATER HEATER:
BLOCK:
STAT~'
~/?
SUBDIVISION'
PHON~'
7<//-:::Z /'72
ZIP:
/? ...;:z..,,;,/ -"~~-'
( ?"' /~v'/~~ '.vy
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~/'9 -5'~;?~f!F
DEMOLISH
OTHER
ADDRESS
CONST,
CONTRACTOR'
PHONE
REQUIRED INSPECTIONS
D Rough Mechanical - PrIor to
cover.
o Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
ele~trlcal power,
o Fireplac'e - PrIor to facing
materials and framing Insp.
IKJ Framing - Prior to cover.
o Wall/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping.
o Wood Stove - After 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.
D Fence'- When comprete~.
D Street Trees -"When' all requi"red-"
trees are plant~d. . :.
EXPIRES
FLOOD PLAIN:
ZONING CODE:
. OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE:
To request an inspectlon, you must cal/ 726-3769. ThIs is a 24 hour r'ecordlng. AI/Inspections requested before 7:00 a.m. will be
made the same workIng day. inspections requested after 7:00 a.m. ~III be made the following work day.
'- OFFICE USE -
LAND USE:
. OF UNITS'
CONSTR. TYPE:
HEAT SOURCE:
-'TN.
o Temporary Electric
. D Site Inspection - To be made
after excavation, but prior to
setting forms.
O' Underslab Plumbing/Electrical/
. Mechanical - Prior to cover.
o Footlng - After trenches are
excavated.
o
Masonry - Steel location,.bond
bea~s, grouting.
o Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
o Underfloor Plumbing/Mechanical
- Prior to Insulation or decking.
o
POst and Beam - Prior to floor
insulation or decking. .
D Floor Insulation - PrIor to
decking,
o
Sanitary Sewer - Prior to fillIng
trench.
o
Storm Sewer - Prior to filling
trench.
o Water Line - Prior to filling
trench.
D Rough Plumbing - Prior to
cover.
RANGE:
o
Final Plumbing - When all
plumbing work Is complete.
D Final Electrical - When all
electrical work is complete.
, .
o Final Mechanical - When all
mechanical work Is complete.
[;[] Final Building - When all
requIred Inspections have been
approved and building is
completed.
o Other
MOBILE HOME INSPECTIONS'
o Plumbing Connections - When
home has been connected to
water and sewer.
o Electrical Connection - When
blocking, set-up, and plumbing
inspections have been app'roved
and the home is connected to
the service panel.
o Final - After all required
. inspections are approved and
. "porches, skirting, decks, and
.venting have been Installed.
Lot faces
lot sq: ftg,
Lot coverage
Topography
Total height
....:.....:, '..'
lot Type ...
Interior
Corner
Panhandle
Cul-de-sac
BUILDING PERMIT
ITEM SQ, FT, X $/SQ, FT,
Main
Garage
Carport
-&r~E~/'.=/f.r
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
I PL. HSE GAR
IN
Is
Iw;.,
IE "
VALUE
q~.-
/ S:-=>""
~75
;e;: 7')
SYSTEMS DEVELOPMENT CHARGE (SDC)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT.
Water
FT.
FT,
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(B)
(C)
Mobile Home
MISCELLANEOUS PERMITS
(D)
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
FEE
State Surcharge
?~ ~W,..c-c,,:..~cE 9.?5
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical) :25<;2::>
(A, B, C, 0, and E Combined)
Setbacks
~ PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
C09rdinator prior to permit issuance.
Accl
I
... I
..;
APPROVED' ,
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted Qn the express condition that the said
. construction shall; in all respects, conform to the Ordinance
adopted by the City of Springfieid, 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:
"1..75"
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 arr 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
on the site at, aa~1I tli'hm s durlng~onstr. tIO~.
Signature ~ aJ. l:2eUV
'-'_1./
Date ~3/9/
VALIDATION:
RECEIPT NUMBER --:<//M /
"7- 7""'7 ,/
AMOUNT RECEIVED _ -:z $::, ")0
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DATE PAID
RECEIVED BY