HomeMy WebLinkAboutPermit Building 1991-6-21
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
e.
.
JOB NUMBER
q/t?~65"
SPRINGFIELD
225 Fifth Street
Springfield, Oregon 97477
LOCATION OF PROPOSED WORK' q~c::;~ IIAYJ?~__ ;g/.?/~E r'?/::>.
ASSESSORS f'.!lAP: /7-0-:?-/'9.:?2 TAX LOT: ~~/
LOT:
BLOCK:'
OWNER' 7)A,?l/;y 7h-.o)',?~~/
'ADDRES'" ?~E
CITY- 5;oPL.D
SUBDIVISION:
O/yy.c~" -/'7'~-gn/
PHON e' 7~- <;'2.. Y /
STATE:
-e>p ZIP'
DESCRIBE WORK: /b~7RC~c:/ '2-yrx 28' c::/~~, D-c/~~
NEW)( REMODEL ADDITION DEMOLISH OTHER
CONTRACTOR'S NAME
GENERA" ~..-'</"""""';:lf'
PLUMBING'
MECHANtCAL'
ELECTRICAl'
ADDRESS
CONST.
CONTRACTOR #
PHONE'
EXPIRES
- OFFICE USE.-
QUAD AREA" LANDUSF' FLOOD PLAIN'
# OF BLDGS: # OF UNIT'" ZONING CODE:
OCCY GROUP' CONSTR. TYPE: # OF BDRMS:
# OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGF' 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
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Unde"rslab Plumbing/Electrical I
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting."
"I':/t' Foundation - After forms are
~erected but prIor to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D
Underfloor Plumbing/ Mechanical
- Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
o Floor Insulation - Prior to
decking.
D Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench.
D Waler Line - 'prior to filling
trench.
D Rough Plumbing - Prior to
cover.
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,
D Fireplace - Prior to facing
materials and framing Insp.
~Framfng - Prior to cover.
D Wall/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
D Wood Stove - After installati~n.
D Insert - After fireplace approval"
and Installation of unit.
D 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.
D,Street Trees -:' When'af, re cfu I red '
trees are planted.
D 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.
KA' Final Building - When all
~requlred inspections have 'been
approved and building is
completed.
o <?ther
MOBILE HOM~, INSPEctIONS
.
D Blocki,ng 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
venting have been installed.
Lot faces
Lot Type .
Interior
Lot sq. ftg.
Lot coverage
Corner
Topography
Total height
Panhandle
Cul-de:sac
BUILDING PERMIT
ITEM SO. FT. . X $/SO. FT.
Main
-.-.
. THE PROPOSED WORK IN THE
'lll!!'l'ISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this appl1cation must be signed
and approved by the Historical
Coordinator prior to permit issuance.
I P.L.
IN
Is
Iw
IE
Setbacks
'HSE GAR'ACCI
I
I
I
I
VALUE
Garage
b "7"Z-
19-/0 9Y.::'5. ~-
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
~a~O
.:tc7~
Pit. 51
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
-lJ./A
,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)
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
ft
Curbcut
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C. Do and E Combined)
FEE
~5:!
- ,
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the expre~s 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 of said ordinances.
Plan Check Fee:
,5':? <;~
!i'-3'/--9/
Date Paid:
Rece'pt Number' ~:;r:j'C
~ece'~"~~~~ 7L
a s Reviewed Sy ~ ~p
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
on the site ~mes during construction.
Slgnatur.-Y.-/ ~~- - ~
~ ,.-
~ --Z/- 'l/
Date y G ~ r/
VALIDATION:
RECEIPT NUMBER -:70 <2/5 Y
DATE PAID 6-2/'''7/
AMOUNT RECEIVED. SSI' > ") 3
> ~/' /~~
RECEIVED BY / /-----~ L ~..-.-_..:>--.
/f'/ /-- -"" --