HomeMy WebLinkAboutPermit Building 1999-01-223ts7
RESIDENTIAL
PERMIT APPLICATION
lnspectlons: 720-3769
Office: 726-3759
SPRIltGFIELD
.JOB NUMBER ?10 o 7
225 Fifth Street
Sprl ng f leld, Oregon 97 477
\bs5 b\-iLOCATION OF PROPOSED WORK:
ASSESSORS MAP:/70 j 2 t 3L
TAX LOT:Lo 7oo
LOT BLOCK:
L
\8\€,pPHONE:
1.1 ??STATE:ZIP:
I-e>+\edE,z^A -r[-aor,>e_S\
D'lL
OWNER:
ADDRESS:
CITY:
NEW
-
REMODEL ADDITION DEMOLISH OTHER
€r fr.o-Fre, Oa,'-f<-qu.,to<DESCRIBE WORK:
CONTBACTOR'S NAME ADDRESS
JtrN\lA
x--
GENERAL:\trc-cN\EXPTRES ,) PHONE
PLUMBING:
MECHANICAL:
ELECTRICAL:
CONST.
CONTRACTOR #
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspections requested before 7:00 a.m. will be
made the same worklng day, lnspections requested after 7:00 a.m. wlll be macle the following work day.
Temporary Eleclrlc
. REOUIRED INSPECTIONS
/l( n [(ough Mechantcal - Prior to: cover.
Fin mbing - When all
I bing worl< ls complete.
Slte lnspectlon - To be made
after excavatlon, but prior to
setting forms.
h Electrical - Prior to Fi rl Electrical - When all
trical work is complete.cover.
Underslab Plumblng/ Electrlcal /
Mechanlcal - Prlor to cover.
Electrical Servlce - Must be
approved to obtaln permanent
electrlcal power.
al Mechanlcal - When all
anical work ls complete.
Footlng - After trenches are
excavated.Flreptace - Prlor to faclng
materlals and framing lnsp.
Flnal Buildlng - When all
required lnspections have been
approved and building is
completed.Masonry - Steel locatlon, bond
beams, groutlng.mlng - Prior to cover.
E Foundatlon - After forms are
erected but prlor to concrete
placement.
Other
Celling lnsulatlon - Prlor to
t.
Underground Plumblng - Prior
to fllllng trench.ll - Prlor to taplng.
MOBILE HOME INSPECTIONS
Underlloor Plumblng / Mechanlcal
- Prior to lnsulatlon or decklng.Wood Slove - After lnstallation
Post and B€am - Prlor to floor
lnsulatlon or decklng.lnserl - After fireplace approval
and installatlon of unlt.
Blocking and Set.Up - When all
blocklng ls complete.
Floor lnsulalion - Prlor to
decklng.Curbcut & AJrproaclr - After
forms are erected but prior to
placement of concrete.
Plumbing Connections - When
home has been connected to
water and sewer.
Sanltary Sewer - Prior to fllllng
trench.Electrical Connection - When
blocking, set-up, and plumbing
lnspections have been approved
and the home is connected to
the servlce panel.
Sidewall< & Driveway - After
excavation ls complete, forms
and sub-base materlal in place.
Water Llne - Prlor to filling
trench.
Fence - When coiilpleted.
Street Trees - When all requlred
trees are planted.
Final - After all required
inspectlons are approved and
porches, skirting, decks, and
ventlng have been lnstalled.
h Plumbing - Prlor to
SUBDIVISION:
tl
E
tl
E
E
E
E
E
E
tl
Stonn Sewer - Prlor to fllllng
trench.
E
I
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Typ(.
-
lnterlor
-
Corner
-
Panhandle !
-
Cul-de-sac
.-rS THE PROPOSED WORK tN THE -
HISTORICAL DISIRIGT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this appllcatlon must be slgned
arrd approved by the Historlcal
Coordinator prlor to permit issuance.
APPROVED:
P.L.HSE GAR ACC
N
S
E
BUILDING PERMIT t
ITEM SO. FT. X $/SQ. FT.VALUE
(A)
Main
Carport
Garage
4aoo?//0,Q
trt ', 11tfuI
Total Value
Building Permit Fee
State Surcharge
Total Fee
This permit is granted on the cxpress 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.
Plans Reviewed By Date
Plan Check Fee:
Date Paid
Received By:
BUILDING V I.UE
AND BUILDING P
, i5rRru cHEcK
ERMIT
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within tlre City limits which are being improved.
ITEM
Fixtures
Residentlal Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
5
(c)
l.{o /.rz
FT.
FT.
PLUMBING PERMIT
9o. oc
{'l,ro
FEE
5'12
Plumblng Permlt
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Note:
Building Inspector may require
aciditional plans information.
and/or fees for the completion of
this project.
By slgnature, I state and agree, that I have caref ully examlned
the completed application and do hereby certlfy that all
lnformation hereon is true ancl correCt, and I f urther cerflfy
that any and all work performed shall be done in accorrJance
with the Ordinances of the City of Sprlngfield, and the Laws
of the State of Oregon pertalnlng to the work descrlbed
herein, and that NO OCCUPANCy will be made of any
structure wlthout perrnission of the Building Safety Division.
I further certify that only contractors and enrployees who
are in compliance with ORS 701.055 will be used on thls
proiect.
I further agree to ensure that all required inspections are
requested at the proper tlme, that each address ls readable
from the street, that the permlt card ls located at the front
of the property, and the approved set of plans will remaln
on the site at all times during construction.
[,-aJ-^??
L.e^-.J
Date
Signatu
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
MISCELLANEOUS PERMTTS
Moblle Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolltlon
State Surcharge
Total Miscellaneous Permits (E)
lf '/o
te: !!
rr.7i
LC'va
(rr
(D)
MECHANICAL PERM!T
Furnace
Exhaust Hood
Vent Fan No
Mechanical Permit
lssuance
State Surcharge
Total Permlt
TOTAL AMOUNT DUE (excluding etectricat)
(A, B, C, D, and E Comblned)
rf
z0
VAI.IDATION
RECEIPT NUMBER
DATE PAIi)
AMOUNT RECEIVED
RECEIVED BY
Flecei pt Number:-
N',--_
o2/LL/98 LO:22 6Sos 726 3689
225 YIYnE SltEEf, &
SPSJNGEIEu), oRBGON
INSPECTTON REQIIESf,:
O?BlCEz 726-3759
zoning, and does
project
not
AS
require
submltted
specific
hasapproval
Zoning ft_
Date
Ultn, sisnature
726-3769
SPFD DEY. SER
D
0
s 40.00
@ oor
Sum
SPRrr{GFIELD
1.TTON OF
I,EGAL a ro
DESCRTPTIOII
Permirs are non-transferable expirelf uork is not started uithin 1
suspepd
Signature of Supervislng Electrician
Ovner
Address l365 fl^lt r.ryr,n^-d-rl
Ci ty Phone
OSNER INSTALIATTON
for sale, lease or renc.
Omers Signature:
DATE:
the followino
,and use '
BIACTRICIIL PERI{IT
Ci ty Job lftrsber
3. CII{PLSIE PEE SCEPDI'I.E BBIOII
A. Nes tial-Si ngle or
1y ling unit.
the
Each Hanu
#w
hs,
days
ed forof'lssuance or if vork is
180 days.
Hodular 'Dvel1ing
Sertice or Feeder
2. COIII?ACTOR TNSTAIJ,ArIOII 3. Serv.i.ces or FeedersInstallation, Alterations
or Relocation:Electrical Contractor
Address S/ 2, /./ .4rr.200 amps or less $
ciry-=z{r; t?n^( phone 3 /8-? Z"Z $
Supervisor Lic ense Number ;9za-5
Expiration Dar C. Temporary Services or Feeders
$40
Installation, Alteration or Relocation
Expiration Date
00
00
@
00
00
00
50
60
100
30
Nev, Alteration or Extension Per Panel.
one Circuit S 35.00
Each Addi tionalCireuit or vith Service
or Feeder Peruit $ 2.AO
200 anps'sr less
201 aups to 400 anps:
Over 401 to 600 anos
Over 600 amps or fOOOEIIT
Branch Circuits
-Each installation
Pump or irrlgation
sign/Outline - Ligh tine-
Limited Energy/Res
s
$,$ss
40.00
5s.00
80.00
ee rBr affi
The installation is being nade on
property I oun rrhiih is not intended
E. Hiscellaneous (Service/feeder not included)
s 40.00
$ 40.00
$ 20.00
$ 36.00
5. SUBTOTAL OF ATOVE
5Z State Surcharge
32 Administrative Fee
TOTAL
CITY OFSPE OFEGOIV
RECSII/ED
* tat
amps
Constr contr. Nuraber /7ZgZ
anPs
400
600
I
0L/22/Sg 16:28 FA-X 5417263687 SPFLS DCO TR +++ ADMIN a Eot
JoL #
TO:
FR0l't:
SUBJECT:
Address or location of building 3
Name of ouner
Type of building
Building Department
Spri ngf i e'l d Fi re Deparbnent
Structural Damage to Building
FIRE DAI.IAGE REPORT
OR
ELECTRICAL HAZARD
tlwel ]ing, S , lrlarehouse,
6d
q?oaq /
170 3zs 3 z ta q0a
DATE: / -JJ -??
)
q
o ,ty's
Est'imated val ue of bui l di ng
Estimated loss to buildinq
Date of fire
Location of damage in building
.1r*-i .4
Roo , l,la'll, Exterior, Interior, etc.
Structlra'l weakness as a resu]t of the fire
I
Burned rafters, Beams, Jolsts, etc.)
IAdditional pertinent .infonnation
{r-.,*?nrrrJ A,O.,o,a /t,t 17n.l a ,i r,n Je-o au*iqu/,
Electrical tlazard
(l'ri ring, 0utlets, €tc.
7
l,
cc:.ZZ-
Slgned
{
I