HomeMy WebLinkAboutPermit Building 1991-9-27 (3)
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
.
SPRINGFIELD
,
JOB NUMBER q //C:>-W
225 Fifth Street. ..d6ll
Springfield, Oregon 97477 ~
LOCATION OF PROPOSED WORK: -;29~9 /&~E4!V t9~. ~?::> . . -
ASSESSORS MAP' ~R r 6P /7-<::>::r ~ /'9- ~<... TAX L9T: _ ~ ~ ~
LO~: /~.€/ '3 . . BLOCK' SUBDIVI~IO~~~s..>w.(~-:p.?~
..r........""",
L . L.tPY.-r;>~-KF~
~ 7?:Z-- ~ ,
OWNER' /!/<:51>FB'
ADDRESS: _7~~ ff~
5?.,Q-i::::>
/
DESCRIBE WORK: ~~~~
NEW X REMODEL ADDITION
CITY'
CONTRACTOR'S NAME .
GENERAL: PfAr~ G-??'-
pLUMBING'
MECHANICAl'
ELECTRICAl'
QUAD AREA:
<; flN c.-
/
~~M
. OF BLDGS:
OCCY GROUP:
. OF STORIES:
WATER HEATER: 4~
STATF'
~.
PHONF'
'7~.q/.?~
ZIP:
&??C/? 7
./bX;tZ/.~~c;-_~~
,
REQUIRED INSPECTIONS
r7l Rough Mechanical .- 'Prio~ to
~ cover.
ell Rough Electrical - Prior to
cover.
[lI Electrical Service"": Must be
approved to obtain permanent
electrical power. . p
D Fireplace - Prior to facing
materials and framing Insp.
C:(] Framing - Prior to cover.
[2] Wall/Ceiling Insulation ,.- Prior to
cover.
IZl Drywall - Prior to_ t_aPing.~
o Wood Stove - After installation.
o Insert - After fireplace approval
and Installatlon 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.
D Fence - When completed.
D Street ,Trees - Wh~n~ all .req~ired
trees are planted. '." .
,
EXPIRES
PHONE
DEMOLISH
OTHER
FLOOD PLAIN:
Q~A""""" ~
ADDRESS
CONST.
CONTRACTOR'
,ZONING CODE:
. OF BDRMS'
SECONDARY HEAT:
SQUARE FOOTAGE:
~ )::J
- OFFICE USE -
LAND USE:
U1J
I
vIII
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.
[K]
Underslab Plumbing I Electricall
Mechanical - Prior to cover.
~ Footing - After trenches are
excavated.
o Masonry - Steel locatIon, bond
beams, grouting.
r;::7l Foundation - After forms are
Ii1-J erected but prior to concrete
placement.
IKl
Underground Plumbing - Prior
to filling trench.
D
Underfloor Plumbing I Mechanical
- Prior to insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
D Floor Insulation - Prior to
decking.
IE] Sanitary Sewer - Prior to mUng
trench. 7~.~c~
[Z] Storm Sewer - Prior to filling
trench. ~ ~.,.IM"~
[K] Water Line - Prior to filling
trench.
[l] Rough PI~mbing - Prio,r to.
cover. .
. OF UNITS'
CONSTR. TYPE:
HEAT SOURCE:~~ /~'.'7>..
RANGE: c::C c-<-/' ,
[E]
Final Plumbing - When all
plumbIng work is complete.
[Xl Final Electrical - When all
electrical work is complete.
[Xl Final Mechanical - When all
mechanical work is complete.
~ Final Building - When all
required inspections have been
approved and building is
completed.
D.Other
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.
o Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
o Final - After all required
.', inspec-!Ions are approved and
. porches, skirting, decks, and'
..:ventlng have been Installed.
Lot faces LL-
Lot sq. ftg. . 5~C>
Lot coverage B-
Topography o-Z~
/:?!/' ,
Total height -
Lot Type t
-A Interior
Corner
Panhandle
Cul.de.sac
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT.
Main
Garage
T
.. THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
//
I PL.
IN
Is
.Iw
IE
Setbacks
HSE GAR ACC
-;18' ~
SF'I
Y3'1
~Q'I. .
VALUE
Carport
/7// ~~~ 5A)< /y./(>
T /
Total Value
~uilding Permit Fee
State Surcharge
Total Fee
(A)
72 /9.:;;;>C
bB.$O
~.W
7/.~?
SYSTEMS DEVELOPMENT CHARGE (SDe)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
.Plumblng Permit
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
(B)
~
N' /)1..4..
FT.
FT.
FT.
(C)
Wood Stove/lnserllFireplace Unit
N'
/
Dryer Vent
~ 7?'p/AtA 7 ~T 5':-
M/ff. as: 6'c>
A:>.-e>
/.:2S"'
~6.;2.5
Mechanical Permit
Issuance
State Surcharge
Total Permit
Mobile Home
MISCELLANEOUS PERMITS
(D)
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
FEE
~.'-'
<0 <Se>
';?,$"P
5"2~~
6.-0
-=J.-
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
/ c5" t'.b~
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 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: _crt/.?3
9-5'~ "
Date Paid:
Receipt Number:~ S ~
Received By: ~~~
. -",. - ,
!,~(
Plans Reviewed By
"1'- zc,. -11
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 c~mpliance 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 all times du~con~
Slgnatur..a ~ ;/:Z:::
Date j.J>~~ ;? 7/7?(
:-
VALIDATION: . .-/
RECEIPT NUMBER 9 /4 -r- Z-
'7--:2-7-//
AMOUNT RECEIVEr> '.; ~J~': ~
RECEIVED BY ~rl/7~t/
DATE PAID