HomeMy WebLinkAboutBuilding Building 1996-05-30SPRIl\IGFIELI)
RESID ENTIAL
PERMIT APPLICATION
lnspections: 726.3769
Office: 726-3759
LOCATION OF PBO
ASSESSOHS MAP:
LOT
F 3
BLOCK:
JOB NUMBER 4 soq ao
225 Fifth Street
Springtleld, Oregon 97 477
TAX LOT;
SUBDIVISION:
PHONE:1'11 - O3A'L
STATE:C\fL ZIP:9tl7BCITY:
ADDRESS:
OWNER:
r^oJo-L
ADDITION DEMOLISH OTHER
DESCRIBE WOFIK:
NEW- REMODEL X
MECHANICAL:
-
FI trCjTRICAL
EXPIRES PHONE
CONST.
CONTRACTOR #CONTRACTOR'S NAME O trrnr-'r- ADDRESS
GENERAL:
PLUMBING
- OFFICE USE -
C OF BDRMS:
RANGF.:
ZONING CODE:
FLOOD PLAIN:
WATER HEATER:
# OFdNITS:
LAND USE:
SECONDARY HEAT:
SOUARE FOOTAGE:
QUAD AREA:
r OF BLDGS:
OCCY GROUP:
* OF STORIES:
CONSTR. TYPE:
HEAT.SOURCE:
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour rccordlng. All lnspections requested before 7:00 a.m. wlll be
made the same worklng day, lnspections requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
[--l Temporary Eleclrlc Rough Mechanlcal - Prior to
cover.
Final Plumbing - When all
plumblng worl( ls complete.
Site lnspection - To be made
after excavatlon, but prior to
settlng forms.
Rough Electrical - Prior to Final Electrical - When all
electrical work is complete.cover,
Underslab Plumblng I Electrical,
Mechanlcal - Prlor to cover.
Electrical Service - Must be
approved to obtaln Permanent
electrlcal power.
Final Mechanical - When all
mechanical worl< ls cornplete.
Footlng - After trenches are
excavated.Flreplace - Prlor to faclng
materlals and lraming lnsP.
Final Building - When all
required lnspections have been
approved and building is
completed.Masonry - Steel locatlon, bond
beams, groutlng.Framlng - Prlor to cover.
Other
Foundatlon - After forms are
erected but prlor to concrete
placement.WalllCelting lnsulatlon - Prlor to
cover.
Underground Plumblng - Prior
to filllng trench.[-l Drywall - Prlor to taoing
MOBILE HOME INSPE TIONS
Underlloor Plumblng/ Mechanlcal
- Prlor to lnsulatlon or decklng,[-l Wood Stovo - After lnstallatlon
Post and Beam - Prior to floor
lnsulatlon or decklng.lnsert - After flrePlace aPProval
and lnstallatlon ol unlt.
Blocking and Set-Up - When all
blocking ls complete.
Floor lnsulation - Prlor to
decking.Curbcut & AlrProach - After
forms are erected but Prior to
placement of concrete.
Plumbing Connections - When
home has been connected to
water and sewer.
Sanitary Sewer - Prior to filling
trench.Electrical Connection - When
blocking, set-up, and plumbing
lnspections have been aPProved
and the home is connected to
the service panel.
Storm Sewer - Prior to filling
trench.
Sidewalk & DrivewaY - After
excavation ls complete, forms
and sub-base materlal in Place.
Water Llne - Prior to filling
trench.
Fence - When comPleted.
Slreel Trees - When all required
trees are planted.
Final - After all required
inspections are approved and
porches, skirting, decks, and
ventlng have been installed.[flnoug]t Plumbing - Prior to
-
cover.
I
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P.L.HSE GAR ACC
N
S
E
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Tyl _.
-
lnterior
--
Corner
-
Panhandle
-
Cul-de-sac
IS THE PROPOSED WORK iN THE
HISTOHICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this applicatlon must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED:
VALUE
(A)
x $/so. FT.
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SQ. FI.
Main
Garage
Carport
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on lhe express condition that the said
construction shall, in all respects, conform to the Ordinanceadopted by the City of Springfield, including the
Development Code, regulating the construction and use ofbuildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plans Reviewed By Date
Fleceipt Numbe
Date Paid
Received By
Plan Check Fee
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City linrits which are being improved.
ITEM
Fixtures
Besidential Bath(s)
Sanitary Sewer
Water
Storm Sewer
FEE
(c)
cxf
2(-
No
e
PLUMBING PERMIT
Mobile
FT.
FT.
Plumbing Permit
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Fl replace Unit
Dryer Vent
MECHANICAL PERMIT
(D)
Mechanical Permit
lssuance
State Surcharge
Total Permit
Fu rn ace
Exhaust Hood
Vent Fan
s
By signature, I state and agree, that I have caref ully examined
the completed application and do hereby certify that all
lnformation hereon is true anct correct, and I f urther cerilfy
that any and all work performed shall be done in accordance
wlth the Ordinances of the City of Sprlngfield, and the Lawsof the State of Oregon pertainlng to the work described
herein, and that NO OCCUPANCy will be made of any
structure without permission of the Buildirrg Safety Divislon.I further certify that only contractors and employees who
are ln compliance with OBS 7Oi.O55 wlll be used on thlsproiect.
I further agree to ensure that all required inspections are
requested at the proper time, that each address ls readable
from the street, that the permlt card ls located at the frontof the property, and the approved set of plans will remaln
on the site at all times during construction.
Date o/s 6
tu re
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
--
ft
Curbcut .- ft
Demolition
State Surchargp
Total Miscellaneous Perrnils (E)
-7TOTAL AMOUNT DUE (exctuding electricat)
(A, B, C, D, and E Combined)
IV
t\
RECEIVED BY
VALIDATION:
RECEIPT NUM
DATE PAID
AMOUNT R
. FT.
N0
s/s
\
CITY OF OFEGO'U
SPRINGFIEID, oREGoN 97411 - -)-Eaf
INSPECTION REQT EST: 7264%*
approval.
225 FTTTE STRXET
OFPICE: 726-3759 Auihorizad
1. LOCATION OF INSTALT^ATION
LEGAL
JOB DESCRTPTION
/r*t,*-.e Fs*rnzp./ To A.
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTALLATION OT.ILY
Electrical Contractor
Address
city- Phone
Supervisor License Number
Expiration Drte
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Ovners Name
Address
ELECTRICAL PERHIT APPLICATION
Ci ty Job Number o
3. COHPI,ETE FEE SCMDULE BELOV
A Nev Residential-Single or
Multi-Family per dvelling unit.
Service f ncl-uded:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dvelling
Sertice or Feeder
s 8s.00
s 1s.00
$ 40.00
B. Services or Feeders
Installation, Alterations
or Relocation:
The following proiect es euhmitJed hap the foliowing
ioning, anO?begnot require spacilic larld use
SPftI 'IELT)
200 amps or less ?
201 amps to 400 amps
-401 amps to 600 amps _601 amps to 1000 amps_
0ver 1000 amps/vo1ts
Reconnect OnIy
SUBTOTAL OF ABOVE
5% State Surcharge
37" Administrative Fee
TOTAL
Sum
&s s0.00
s 60.00
$100.00
s130.00
P,
s300.00
s 40.00
c.
D
E
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps"or less $ 40.00
201 amps to 400 amps
-
S 55.00
over 401 to 600 amps
-
S 80.00
0ver 600 amps or 1000 voTIs see uB* a66E
Branch Circuits ;/*-
<..
c:,ty Wd Ynone 7/7- O3Z,z
OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Omers Signature:
DATE:
Nev, Alteration or Extension Per Panel
One Circuit $ 35.00
Each Addi tionalCircuit or vith Serviceor Feeder Permit I S 2.00 /4.
Miscellaneous { Service/feeder
-Each ins tall-at ion
Pump or irrigation SSign/0utline Lighting- SLimited Energy/Res
-
$Limited Energy/Comm S
)*/
not included)
40.o0
40.00
20.00
RBCEIVED
5 a?
<775 D4ruet: ,<TT
CITY OF OBEGO'V
S"FTINGFIELD
D EVELAP M ENT S ER Vl C ES DE pA R r !\r E fiT
December 6,1996
225 FIFTH STBEET
SPRINGFIELD, OR 97477
(s41 ) 726-s7s3
;AX (5d1)726-36,c!)
Terry Bollenbaugh
3735 Oregon Street
Springfield, OR 97478
Dear Mr. Bollenbaugh,
Your request for an extension ofyour permit to convert your garage in to a bedroom at your residence,
located at3735 Oregon Street, Springfield, Oregon, City Job number 950980 has been reviewed and
approved.
This extension may only be granted one time and will expire 180 days from the granting of the extension
(June 6, 1997).
If you have any questions or if I may be of further assistance, please call me at 126-3664 .
I
I 'l*[^t,
i1-
Communify Secretary
cc: Dave Puent, Community Services Manager/Building Official
hk
,!r/, t /ri u
Re6rr.r-t* {". B,.lJ,^6 (fet^,'l E*lenr,r,.- Rn,,.'t * qS cqgo
T an^ rs
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r)
T wil\ ##,c-
;/zt I 1u ,
2)
tr^4-5 n ^b o\,^r\ CtL{ernS..'tf {--^7 b,*^d'^6 Pc--r' it.
D.^o- to lr"^lt6 neorls A \a^.,u ,'ro* hr..l t r..r-tc
fr.. ,3 [
F. nds ra-y\ s"h.cr+
U=--rea&5--fa--*t Ga-cl- t o,sp+a-*ic,,-'-h?.
/-^ t &{!"^C/%A
3l3s O.1A^ St
1p.'5{ulL4r< a7!79
7.17-o 3BZ
3'{Z- lgZ( LrlgrL pl^'cn^r
-ADDRESS-3735 OREGON ST
-INFO-
REPAIR
RESTDENTIAL
l-l-Ll-
OO1-06]._RES PLAN CHECK
OO2-OO2-BUILDING PERMIT
OO3-OO4-BLECTRICAL
004-070-sDc/sroRM
0 05-07 3 -SDC/ADMTN
OO6-OO5-PLUMBING
BUILDTNG DIVISION JOB# 9 )80
_LEGAL-
LOT BLOCK
ACTIVE
-VALUE-
5533
DESCR:REMODEL GARAGE TO BEDROOM L702314300311
_OWNER-
TERRY/MARGARET BOLLE 747-0382
3735 OREGON STREET
sPRrNcFr ELDIOREGON / 97 47 B
950622 / 960531
-ENERGY- -STATS-HEATI- 2_ 1 BLDG ZONE LDRH2O- ]- STORIES FLOODPLAINRANGE- BEDRM OCC GRP R3INSULATION UNITSPATH- SQ FEET 232
CONST TYPE
-CONTRACTORS-
GENL-OWNER
CONTRACTOR PHONE-
PLMB-OWNER
ELECT-OWNER
MECH-
DESGN-
QUAD AREA 3RSC
sEQ-REQUIRED PERMITS- -------FEE--SURCHARGE--DATE--RECPT--CAT-------VALUE
40.63
62 .50
66.00
4.39
0.22
15.00
0.00
3 .13
3.30
0.00
0.00
0.75
950616
9507 25
950725
9507 25
950725
96053 0
oL7 87 2
L8454
L8454
L 8454
L8454
2L7L6
601
500
510
0
6r 533
0
0
0
0
SEQ-MINIMUM INSPECTIONS + REQUIREMENTS-- --EXP DATE---ACT DATE-
FLOOR
SEQ--TNSPECTIONS -COMMENTS------- -----DATE---RSLT--rNSP
001--007-MASoNRY
OO2_OOs-POST & BEAM
OO3-OO9-INSULATION
OO4_OA2-ROUGH ELECTRIC
OO5-044-ELECTRIC SERVICE
OO6-OO6-FRAMING
O O7-O O 9_INSULATION
OOB-011-DRYWALL
O O 9-04g-FINAL ELECTRICAL
O1 O-O 3 g-FINAL MECHANICAL
O1 ]._O ]. g_FINAL BUILDING
012_02 3_ROUGH PLUMBING
013-02g-FINAL PLUMBING
001--002-FooTrNG
OO2-OO7-MASONRY
OO3-OOs_POST & BEAM
004-00g-TNSULATTON U/F
OO5-044_ELECTRIC SERVICE
OO6-044_ELECTRIC SERVICE SUB-CALLED OK TO CONNECT SERVICE.
007-042-ROUGH ELECTRTC C/N FOR FrNAL
O O B-O O 9-INSULATION
OO9-OO6-FRAMING
O1O-o11-DRYWALL LEFT CARD
011-011-DRYWALL 2ND TRIP
OL2_023-ROUGH PLUMBING
9s 0 818
950818
950818
9s0 82 8
9602L2
96 0 213
960509
960524
960524
9605 2 I
9605 2 I
96053 1
950818
95 0818
960524
960509
960 21- 3
960524
950828
960528
WIR 38oK 38OK 38oK 38IRC 6LoK 61oK 51oK 59oK 59UGE 59oK 59oK 28
Permit #:
Address
Issued by:Date: 7-2 5;4f
Statement: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appti-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes I and2, and either box 34 or 38:
1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
3,A'. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and thatl have read and do understand thelnformation
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
applicant)
(White copy to issuing agency perrnitfile,
pink copy to applicant)
t
OR
(Signature (Date)
?SeZO
B
tr
'{ o * BoQ!r^0---..(A t/zs lqs
Information' Notice to Property Owners
About Constructism Hesponsibilities
Nrste : This l*f*rwtcttion Notice to Prtspert;r- *wners sfs*ut {*nstrur:tion Respottsibilities
w.*s rlevef*p*l by the Consiruction"Confr*ttors &oartl in arc*rd*rcce with OkS 7A] "055{5i.
If you are acting *s _vour fiwn c*fitractnr tr: eonstruct fr fiew htme *r rnak* a substantiai impr*vement. to an existing str*cture,
you can prevent many probiems by being aware of the following responsibilities and areas of concern.
EMPLOYEH RESFON$IBILITIES:
If you hire persons not registered with the Construction Contractors Boardto do labor in constnlcting.or assisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees. As the ernployer, you must comply with the following:
Oregon's withhotding tax law: As an employer, you must withhold income taxes frorn employee wages at the time employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax frorn your employees. For more
information, call the Oregon Dept. of Revenue at 945-8091.
Unemployment insurance taxl As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees, Far more information, call the Oregon Employment Division at the Department of Huma! Resourees
at378-3524.
Workers'compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and must
obtain workers' compensation insurance for your employees. If you fail to obrain workers' compensation insurance, you may
besubjecttopenaltiesandwillbeliableforallclaimcostsifoneafyouremployeesisinjuredonthejob. Formoreinformation,
call the Workers'Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Internal Reyenue Service: As an employer, you must withhold federal income tax frcm employees' wages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more infcrrmation, call the Internal Revenue Service
at l-800'829-1040.
OTHER HESPONSIBILITIES AND AHEAS OF CONCEHN:
Code compliance: As the permit holder for this project, you are responsihle for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
Liahility and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage [r:r
accidents and omissions such as falling tools, paint oyerspray, water damage ftnm pipe punctures, fire, or work that musl be
re-done.
Time ta supervise ernployees: Make sure you have sufflcient time ttt supcrvise ynur employees.
Expertise: Make sure you have the expertise to act as your own general c*ntractor, to c*ordinate the work of rough-in and finish
trades, and t* noti$r huilding nfficials at the appropriate tirnes so they can pedorm the required inspections.
If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 973CI9-5052,
5A31378-4521). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-awn.pm4
U94
IoB No .15o18o
CITY OF SPRINGFIELD SYSTEMS DEVEI,OPMENT CHARGE
WORKSHEET
(CoMMERCTAL & RESIDENTIAL)
NAME OR COMPANY TF-B-<v I illnpoop,.zr Bo u LL^/bA U G 11
LOCATION:z1b6 Dt<E Sr l-7o 2?i, 4Z - db zil
DEVELOPMENT TYPE:
BUILDING SIZE:
1. STORM DRAINAGE
TMPERVIoUS SQ. FT.
2. SANITARY SEI,IER-CITY
NO. OF PFU'S
(See Reverse)
SIZ
x $0.209 PER SQ. FT.
X $43.26 PER PFU
. Ft.
ZI
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
x _ x $436.19
x
x
x $436. 19
x $436.19
$
$
4. SANITARY SEWER-Mt,lMC
N0.0F PFU'S x $17.19 PER PFU + $10 Ml.lMC ADM FEE
(Use PFU Total From Item 2 Above)
Mr.rMc CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL-MltlMC SDC
SUBT0TAL (ADD ITEMS 1,2,3 & 4)
5 ADMINISTRATIVE FEES
BASE CHARGE (SUBT0TAL AB0VE) X .0s
$
s+7.1
Ki p Burdick
2Z
SDC Coordinator
Date:a /zz/qE
-17 TOTAL SDC s+(rlI
FIXTURE UNIT CALCULATION TABLE: Number of New Fixture
(NOTE: For remodcls, calculate onty tt ET additional fixturesl
NUMBER OF
FIXTURE TYPE NEW FIXTURES
'' Unit Equivalent :' Fixturc Units
UNIT FIXTURE ,.
EOUIVALENT UNITS
Bathtub..-..2
1
2
6
2
6
6
,l
.)
2
1
2
2
1
6
Drinking Fountain...
Floor Drain-
lnterceptors For Grease/Oil/Sotids/Etc. --. - - -. -.. -- -. -.
lnterceptors For Sand/Auto Wash/Etc. : - - - - - - -. - : - - - - --
Laundry Tub/Clotheswasher..-...-...--
Clotheswasher - 3 Or More.--.-
Mobite Home Park Trap (1 Per Trailer)
Receptor For Refrigerator/Vvater Station/Etc
Receptor For Commercial Sink/Dishwasher/Etc--
Shower. Single Stall.........-
Shower, Gan9......... ...--..-..:..----
Sink: Bar, Commercial. Residential Kitchen
Urinal. Stall/Walt...
Toilet, Public lnstallation.
Toilet , Private
Miscellaneous:
/Head
4
TOTAL FIXTURE UNITS
CREDIT CALCULATION TABLE: Based on assessed value
calculate credits separates.
lf improvements occurred after annexation date in table,
Credit for Parcel or Land Only lf Applicable
lmprovement (if after annexation date)
xs
(Rate X Assessed Value)x $--
(Rate X Assessed Value)
CREDIT TOTAL = $
Year
Annexed
Rate per $ 1,OOO
Assessed Value
Rate per $ 1,OOO
Assessed Value
1979 or before
1 9BO
1 981
1 982
1 983
1 984
1 985
$3.46
3.38
3-32
3.21
3.O6
2-92
2.73
1 985
1 986
1 987
.I9BB
1 989
1 990
1 991
1 993
s2.46
2.14
1.77
1.37
o.97
o.61
o.44
o-15
Year
Annexed
RESIDENTIAL
PERMIT APPL ICATIO N
lnspections:726.9769
Office: 726.3759
LOCATION OF PROPOS WO
ASSESSOBS MAP:
LOT;
SPRIhl GFIELc)
BLOCK:
JOB NUMBER
225 Fif th Street
Sprlngfleld, Oregon 97 477
TAX LOT:
SU BDIVISION:C o),*, d",l {._
At
PHON E?3
ZIP:
e2_)
STATE:r}n
'17*o
OWNEB;
ADDRESS:
CITY:
ADDITION DEMOLISH OTHER
DESCRIBE WORK:
NEW
-
FIEMODEL
ADDRESS EXPI BES PHON E
COco
{O trSn
5c.
CONTBACTOR'S NAME
ELECTFICAL:
MECHANICALI
NSI.
NTRACTOB ,f
G EN ERAL:
PLUMBING
sRS \\\\
- OFFICE USE -
WATER HEATEH:
LAND USE:QUAD AFIEA:
* OF BLDGS:
SECONDARY HEAT:
SOUARE FOOTAGE:
# OF BDBMS: ---
OCCY GROUP;
# OF STOBIES:
CONSTR, TYPE:
HEAT SOURCE:
RANGE:
# OF UNITS:
--
[--l Streel Troos - When ail requlred
-
troes are planted.
To request an lnspecilon
made the sante worklng ' you must call 726'3769. Thls ls a24 hour recordlng, All lnspectlons requested be[ore 7:00 a.mday, lnspectlons requested after 7:00 a.m, will be made the followrng work day.
vrlll be
REOUIRED INSPECTIONS
[*l Temporary Etectrlc Rough Mechanlcal - prlor tocover.Flnal Plumblng - When atlplumblng worl( ls complete.
ii,:;r ff{ffili;, oJio?,:,i:'" F :r"',: E,ecrr,ca, - pr,or to
settlng forms,
UnderslabPlumblng/Electrlcal/ rptMechanlcal - prlor to cover. FJ
Electrlcal Servlce - Must beapproved to obtaln permanent
olectrlcal power.Footlng - After trenches are
excavated.
ffi rvtasonry - Steel locailon, bond.4 beams, grouting.
[-l Flreplace - prlor to factnglJ materlals and framlng lns{
[X Framlng - prlor to cover,
Foundatlon - After forms are
erected but prlor to concreteplacemont.ry Wall/Celllng lnsulatlon - prlor to
cover.
tl l'Jflilfl;"1'!:J;:-tins - Prior
ffiorvwau - prror to raprns
Underlloor Plumblng/ Mechanlcal
- Prlor to Insulatlon or decklng.
MOBILE HOME INSPE TIONS
Wood Stovo - Atter lnstallatlon
ffi Post and Beam - prlor to floorLe lnsulatlon or deck!ng.
[E ftoor lnsulatlon - prlor to
"-+J decklno.
!nsert - ,4.f ter flreplace app,-ovai
and lnstallatlon of unlt.
[-_-l Blocking and Ser.Up - Wnen a,t
'i ht.^^t?t^^ t- ^^_-r_.-rv rr uvrrrPrcle.
Curbcut & Approach - Afterforms are erected but prior toplacomcnt ol concrete,
Plumbing Connectlons - Whenhome has been connected towater and sewer.Sanltary Sewer - Prior to f llling
trench.
Storm Sew€r - Prlor to fllilng
tren ch.
Sldewalk & Drlveway - Af terexcavatlon ls COmpleto, formsand sub-base materlal ln place.
Electrlcal Connection - Whenblocklng, set.up, and plumbing
lnspectlons have been approvedand the home ls connected tothe servlce panel.
Waler Llne - Prlor to filling
trench.'
Fenco - When completed.
Bough Plumblng - Prlor to
cover.
Final - After all required
lnspectlons are approved andporchos, sklrtlng, decks, andventlng have been lnstalled.
C,I -7 LiTn
FLOOD PLAIN:
zoNlNG "oo.,ln
[Q ntnat Etectrtcat - When ail
f electtlcal work Is comptete.
TFFrtnat Mechanlcal - When atr
f mechanical work ls complete,
E(DFtnat Buitding - When ailf requlred lnspections have been/ approved and bullding is
completed,
tl
tl
fi:. t :'
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Typr
-
l' lor\/
-
Corner
-
Panhandle
-
Cul-de-sac
Setback
PL.HSE GAR ACC
N
S
E
IS THE PROPOSED WORK IN THE .
HISTOBICAL DISTRICT, OR ON
THE HISTORICAL REGISTEB?
-
lf yes, thls appllcailon must be slgnedand approvecj by the Hlstorlcal
Coordinator prlor to permlt lssuance,
APPROVED:
Total Value
Building Permit Fee
State Surcharge 3.t3
Total Fee
iBUILDING PERMIT
VATUE
4rffi* Chth 232,t
5. ql
/o*??_
sl(A)
SO. FT, X $/SO. FT,
L1
-ts t.88
ITEM
Main
G arage
Carport
GS_3365.*
BUILDING VALUE, PLAN CHECKAND BUILDING PERMIT
This permlt ls granted on the express condiilon that the saidconstruction shall, ln all respects, conform to the Ordlnanceadopted by the City of Sprln
gulatlng the construcilon and use of
ewed ByPI r/nr /:s
/ DatA
-(r,
a3
By:
gfield, includlng theDevelopment Code, re
ay be suspended or revoked at any tlme
any provislons ol sald ordlnan ces.
tFlec
4-l12
bulldlngs, and m
upon violation of
Plan Check Fee;
Date Paldt
Becelpt Number:,
SYSTEMS DEVELOPMENT cHARqE (SDC)
(B) {4L&Systems Development Charge ls due on all undeveloped
propertles wlthln the City llmits whlch are belng lmproved,
Besldential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
FEE
(c)
N0
FT.
FT,
FT.
Plumbing Permlt
State Surcharge
Tolal Charge
PLUMBING PERMIT
ITEM
Fix tu res
ADDITIONAL COMMENTS
By slgnature, r state and agree, that r have caref uily examrnedthe completed appllcailon and do hereby cerilfy that alllnformatlon hereon is true ancl correct, and I f urther cerilfythat any and all work performed shall be done in accordancewlth the Ordlnances of the Clty of Springfield, and the Lawsof the state of oregon pertarnrng to tho work descrrbedhoroln, and that NO OCCUPANCy wlll be made of anystructure wlthout permisslon of the Bulldlrlg Safety Divislon.I further certlty that only contractors and employees whoare ln compllance wlth OFS 7O1.OSS wlll be used on thlsprolect.
I further agree to ensure that all required lnspecilons arerequested at the proper ilme, that each address ls readabrefrom the street, that the permlt card ls located at the frontof the property, and the approved set of plans wilr remarnon the slte at all ilmes durlng construcilon.
Date l^/,^ir-.
Slgnature
MISCELLAN EOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sidewalk -_..-- ft
Curbcut .-._- ft
Demolitlon
State Surcharge
Total Mlscellaneous permlts (E)
l\,lECHANICAL PERMIT
Fu rn ace
Exhaust Hood
Vent Fan No
Wood Stove/ lnsert/Fireplace Unit
Dryer Vent
Mechanlcal Permlt
lssuance
State Surcharge
Total Permlt (D)
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVEDToTAL AMOUNI DUE (excludlng etectrtcat) 7&. t&(A, B, C, D, and E'Comblned)RECEIVED BY
?--2 9-9 I
tA-