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Home My WebLink AboutPermit Building 1993-04-25RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 PFl ELt) qr, JOB NUMBER 225 Fif th Street Sprlngfleld, Oregon g7477 LOCATION OF PROPOSED WORK ASSESSOHS MAP:3 ./- L TAX LOT: LOT: BLOCK: SUBDtVtStoN t PHON E: STATE:ZIP:CITY: ADDBESS: OWNEB: ADDITION DEMOLISH OTHER DESCRIBE WORK: NEW_- BEMODEL ADDRESS EXPI RES PHON E CONTBACTOR'S NAME MECHANICAL; ELECTRICAL: PLUMBING: G EN ERAL: CONSI. CONTRACTOR # E \\ US \\ I .5 - OFFICE WATEB HEATER: LAND USE: ZONING CODE: FLOOD PLAIN # OF UNITS: SECONDABY HEAT: SOUARE FOOTAGE: , OF BDFMS: - OUAD AREA: * OF BLDGS: BANGE: CONSTR. TYPE: HEAT SOURCE: To request an Inspecilon, made the sante worklng , you must call 726'3769. Thls ls a 24 hour recordlng, All lnspectlons requested before 7:oo a.m. wilt beday, lnspectlons requested after 7:00 a.m. wlll be made the foilowrng work day, REQUIRED INSPECTTONS Temporary Electric Rouglr Mechanlcal - prlor to cover.Flnal Plumbing -- When altplumblng worl( ls complete. Slte lnspectlon - To be madc af ter excavatlon, but prlor tosettlng (orms. [4;;"?h Electrlcar - Prror to Flnal Eleclrlcal - When attelectrlcal work ls complete. [--l Underslab Plumbtng/ Electricat/ - Mechanlcal - Prlor to cover.Eleclrlcal Servlce - Must beapproved to obtaln permanent olectrlcal power. Flnal Mechanlcal - When allmechanical work ls comDlete. Footlng - Af ter trenches are excavated,tf ffiF(nd Buitding - When at,tJ requlred lnspectlonS have beenapproved and bullding is completed.Masonry - Steol locatlon, bond beams, groutlng. Flreplace - Prlor to faclng materlals and framlng lnsp. Foundatlon - After forms are erected but prlor to concrete placem6nt, - -"- [_\.,f4ramlng - Prlor to cover. f),X(alllCelllng tnsutarton - prtor rol-..g cover. -/- J ul.,6rVwafl - Prlor to taplng. Othsr Underground Plumblng - prior to fllllng trench. l-_l Underttoor Ptumblng/Mechanlcal Prlor to lnsulatlon or decklng. MOBILE HOME INSPE TIONS Wood Slovo - After lnstallatlon Post and Beam - Prlor to floor lnsulatlon or decklng.lnsert - After flreplace approval and lnstallatlon of unlt. [-_l glocklng and Ser.Up - When ajt - blocklng ls complete. oor lnsulatlon - Prlor to Plumbing Connectlons - Whenhome has been connected to water and sewer. deckl n g Curbcut & Approach - After forms are erected but prior toplacomont of concrete.Sanltary Sewer - Prlor to fllllng tronch. Storm Sewer - Prlor to fllllng trench. Sidewalk & Drlveway - After excavatlon ls completo, forms and sub-base materlal ln place. Electrlcal Connection - Whenblocklng, set.up, and plumbing lnspections have been approved and the home ls connected to the servlce panel, Water Llne - Prlor to filllng trench.' Fence - When completed Street Trees - When all roqulred trees are planted, Flnal - Af ter all required lnspectlons are approved andporchos, sklrtlng, decks, andventlng have been lnstalled. Bough Plumblng - Prlor to cover. h//), OCCY GROUP; I OF STORIES: tf tf tl tl n tl tl Lot faces Lot sq, f tg, Lot coverage To pography Total helght Lol Typ*_ - Interior -- Corner - Panhandle - Cul.de-sac Se P.L.HSE GAR ACC N S E IS THE PROPOSED WORK IN THE ..HISTORICAL DISTRICT, OB ON THE HISTORICAL FIEGISTER? - lf yes, thls appllcailon must be slgnedand approved by the Hlstorlcal Coordinator prlor to permlt issuance. APPROVED: ?i- @ __lg-Y 5.4t9 BUILDING PERMiT VALUE 3.^{3+ 32 (A) ,84,-Ca)Q<yd) ?,7c /o2 SO. FT, X $/SQ. FT,ITEM Main Garage Carport Total Value Building Permit Fee State Surcharge Total Fee qllllDtNc VALUE, PLAN CHECKAND BUILDTNG PERMIT Thls pef.it ls granted on the express condrilon that the saidconstruction shall, ln all respects, conform to the Ordlnanceadopted by the City of Sprlngfletd, includtng theDevelopment Code, regulatlng ine Jonstiuciton and use ofbulldlngs, and may be suspended or revoked at any trmeupon violatlon of any provisions ol sald ordlnances, Plans ewed By FI te ,tI elved B v: 53 Date Paid Recelpt Number: Plan Check Fee: SYSTEMS DEVELOPMENT CHARGE DC (B) Systems Development Charge ls due on all undevelopedpropertles wlthln the City llmits which are belng lmproved. ITEM Fix t u res Hesldenilal Bath(s) Sanitary Sewer Water Storrn Sewer Mobile Home FEE No FT. FT. FT, (c) PLUMBING PERMIT Plumblng permlt State Surcharge Total Charge DrTtottAL COMMENTS ^,{ Wood Stove/ lnsert/Flreplace Unit Dryer Vent MECHANICAL PERMIT cl(D) N0 Mechanlcal permit lss uance State Surcharge Total Permlt Furnace Exhaust Hood Vent Fan By slgnature, I state and agrss, that I have caref ully examlnedthe completed appllcailon and do hereby cerilfy that alllnformatlon hereon ls true and correct, and I f urther certlfythat any and all work performed shall be done ln accordancewlth the Ordinanccs of the Clty of Sprlngfield, and the Lawsof the State of Oregon pertalnlng to tho wor[< descrlbedhoroln, and that NO OCCUPANCy wlll be made of anystructure wlthout permission of the Buildlrrg Safety Division,I further cerUfy that only contractors anOimptoyees whoare ln compllance wtth ORS 7Ot.O55 wlll be used on thlsproJect. I further agree to ensure that all requlred lns Date \<,(_- pections arerequested at the proper ilme, that each address ls readablofrom the street, that the permlt c ard ls located at the frontof the property, and the appro ved set of plans wlll remalnon the slte at all ilm es durlng constructlon. Slgnature MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk -..- ft Curbcut tt Demolitlon State Surcharge Total Mlscellaneous permlts (E) - VALIDATION: FIECEIPT NUMBER DATE PAID AMOUNT RECEIVEDTOTAL AMOUNf DUE (excludtng electricat)(A, B, C, D, and E Combtned) 1 RECEIVED BY 7/3 3 7f __327/? e SP,rII\.GFTELO RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Offlce: 726-3759 JOB NUMBER 225 Flfth Street Sprlngfleld, Oregon 97477 LOCATION OF PBOPOSED WOBK: S MAP:'D3 -Zz-t3 3i77 e €"nr Blvo BLOCK: oR. TAX LOT 300 SUBDIVISION:LOT:/r> ?e,rtN e lsf"'vtt-BqsPHONE: g'7r) STATE:ZIP: C) CITY: OWrueR: ADDRESS: Str) f P., "d<l z Poack &I/es l{< NEW - BEMoDEL V' ADDrroN DEMoLTSH orHER RroDESCRIBE WORK: ADORESS EXPIRES PHONECONTRACTOR'S NAME MECHANICAL: ELECTRICAL: PLUMBING: GENERAL: coNsT. CONTRACTOR # r OF BDRMS: - OFFICE USE - LAND USE: WATER HEATER: ZONING CODE: FLOOD PLAIN r OF UNITS: QUAD AREA: r OF BLDGST SECONDARY HEAT: SQUARE FOOTAGE: CONSTR. TYPE: HEAT SOURCE: To request an lnspectlon, you must call 726'3769. Thls ls a24hour recordlng. All lnspecilons reguested before 7:00 a.m. wlll bemade the same worklng day, lnspections requested after 7:00 a.m. wlll be made the followlng work day. REOUIRED INSPECTIONS [-l Temnorary Etectrlc Rough Mechanlcal - Prlor to cover.l-_l Ftnat Plumbtng - When ail'J plumblng work ls complete. Slte lnspectlon - To be made after excavatlon, but prlor to setting forms. l-l Rough Electrlcal - prior tot-l cover-Flnal Electrlcal - When all electrlcal work ls complete. [--l Understab PtumblnglEtectrical/u Mechanlcal - Prlor to cover.Electrlcal Servlce - Must be approved to obtaln permanent electrlcal power. Flnal Mechanlcal - When all mechanlcal work ls complete. E Footlng - After trenches are excavated.W Flnal Bulldlng - When ail requlred lnspectlons have been approved and bulldlng ls completed.Masonry - Steel locatlon, bond beams, groutlng. tf w w Flreplace - Prlor to faclng materlals and framlng lnsp. Framlng - Prlor to cover. Foundatlon - After forms are erected but prlor to concrete placemont.WalllCelllng lnsulatlon - Prlor to cover. Underground Plu to fllllng trench. mblng - Prior [Z Drvwall - prlor to taptng. l-l Unde;ltoor Ptumblng J ttJlechan!ce! Prior to lnsulatlon or decklng. MOBILE HOME TNSPECTIONS Wood Slove - After lnstallatlon. Post and Beam - Prlor to floor lnsulatlon or decklng.lnsert - After flreplace approvql and lnstallatlon of unlt. l--l Alocklng and Set.Up - When ail - blocklng ls complete. Floor lnsulatlon - Prlor to decklng.Curbcut & Approach - After forms are erected but prlor toplacement of concrete. Plumbing Connectlons - When home has been connected to water and sewer. l-l Sanitary Sewer - Prtor to filting - trench. l--l Storm Sewer - prior to fililng.J trench. Sldewalk & Drlveway - After excavation ls complete, forms and sub-base materlal ln place. Fence - When completed. Electrlcal Connecllon - Whenblocklng, set.up, and plumblng lnspectlons have been approved and the home ls connected tothe servlce panel. Water Llno - Prlor to filling trench. Rough Plumbing - Prlor to cover. Streel Trees - When all requlred trees are planted. Flnal - After all required lnspectlons are approved andporchos, sklrtlng, decks, andventlng have been lnstalled. GAriEhRm Vi rlt+oe DF ?7177 OCCY GROUP: * OF STORIES: BANGE: E tl n Olher E Lot faces Lot sq. ftg. Lot coverage Topography Total helght Lot Type - lnterlor - Corner - Panhandle - Cul-de"sac Se f THE PROPOSED WORK TN THE , iTrsroRrcaL Drsrnrcr, oR oN THE HISTORICAL REGISTER? - lf yes, thls appllcatlon must be slgned and approved by the Historlcal Coordinator prlor to permit issuance. APPROVED: PL.HSE GAR ACC N S W E BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT Thls permlt is granted on the express condition that the said construction shall, in all respects, conform to the Ordinance adopted by the City . of Springf leld, includlng the Development Code, regulating the construction and use of bulldlngs, and may be suspended or revoked at any tlme upon violation of any provisions of said ordinances. Receipt Number:- ,*^ q?3 P Date Plan Check Fee: Date Paid: Received By: x $/so. FT.VALUE 3755,rch=, a? @.*il (A) ,foTotal Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SO. FT. Main Garage Carport Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B)a6A ADDITIONAL COMMENTS ITEM Flxtures Resldential Bath(s) Sanitary Sewer Water Storm Sewer Moblle Home FEE (c) N0 FT. FT. PLUMBING PERMIT Plumblng Permlt State Surcharge Total Charge - FT. Wood Stove/ lnsert/Flreplace Unit Dryer Vent (D) N0Vent Fan Mechanical Permit lssuance State Surcharge Total Permlt MECHANICAL PERMIT Furnace Exhaust Hood By slgnature, I state and agree, that I have carefully examlned the completed applicatlon and do hereby certlfy that all Informatlon hereon is true and correct, and I f urther certlfy that any and all work performed shall be done in accordance wlth the Ordinances of the City of Springfield, and the Laws of the State of Oregon pertainlng to the work descrlbed hereln, and that NO OCCUPANCY will be made of any structure wlthout permission of the Buildlng Safety Dlvislon. I further certify that only contractors and employees who are ln compllance with ORS 7O1.055 will be used on thls prolect. I further agree to ensure that all requlred lnspections are requested at the proper tlme, that each address ls readable f rom the street, that the permlt card ls located at the front of the property, and the approved set of plans will remain Slgnatu S ring "ODate on the slte at all ructlon. MISCELLANEOUS PERMlTS Moblle Home State lssuance State Surcharge Sldewalk - ft Curbcut - ft Demolitlon State Surcharge Total Mlscellaneous Permlts (E) ") VALIDATION: REcErPr NUMBER /? 6/?_g^s?/7-aDATE PAID AMOUNT FIECEIVED RECEIVED BY TOTAL AMOUNT DUE (excluding electrical) (A, B, C, Q and E Comblned) 76.66 // ,' ,3*' ' ' OREGO'VCITY OF 225 FIFTE STREET L{'7 ) SPRINGFfELD, OREGON 97 477 Authorized TNSPECTION REQUESTz 726-3769 oFFICE: 726-3759 Ci ty 5ft. YnoneT4/;73?3 OVNER INSTALLATION The installation is being made on property I ovn vhich is not intended for sale, Iease or rent. Signature: DATE: use BLECTts.ICAL PERHIT APPLICATION Ci ty Job Number COHPIJTE FEE SCEEDTILE BELOV Nev Residential-Single or MuIti-Family per dve1l-ing unit. Service Included:Items Cost s 1s.00 sPnr'--FlELo SUBTOTAL OF ABOVE 5Z State Surcharge 3Z Administrative Fee TOTAL l#,8,"1.f 'rf::,;fr :&#ffi i,f ffi lr 1. LOCATION OF2"r i22- /3 A/, JOB DESCRIPTION&2 -i- F ii:r\ orlj 7a7,fu, 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. COMRACTOR INSTALLATTON ONLY B. Electrical Contractor Address Ci ty Phone Supervisor License Number Expi ration Date c- Constr Contr. Number Expiration Date Signature of Supervising Electrician D 0vners Name Address /? L000 sq.ft. or fess Each additional 500 sq. ft or portion thereof Each Manuf'd Home- or Modular Dvelling Sertice or Feeder $ 8s.00 $ 40.00 Services or Feeders Installation, Alterations or Relocation: 200 amps or fess 201 amps to 400 amps - 401 amps to 600 amPs - 601 amps to 1000 amps- Over L000 amps/volts Reconnect oniY Temporary Services or Feeders Installation, Alteration or Relocation 200 amps"or less $ 40'00 over 4b1 to 600 amps - $ 80.00 Over 600 amps or fbOO voTts see 'Bu a566 Nev, Alteration or Extension Per Panel one circuit t/ $ 35.00 t5:" Each Additional Circuit or vith Service or Feeder Permit - $ 2'00 Miscellaneous (Service/feeder not included) 3 A Sum s s0.00 s 60.00 s100.00 $130.00 $300.00 $ 40.00 E -Each instaflation Pump or irrigation $ sign/outline Lighting- q Liilltea Energy/Res - $ 40.00 40.00 20.00 36.00 /o5 /, or?z-h_ -7- RECEIVED B I..EGAL DESCRTFTION t--Z nl ul:I 0* \-t- r0l n't AFLE\ ol' W UODt?Fr\'ftai.| Ftll ,N sr2al< oPNa \^/ wrN6w w,t.LL (r"e '.2N)FilTU*a- aor.lvERs fto uv,Na tu furuns (ptlo _a@rhat{o?.- ca$u NEWp1p4g. trNE tcxz4 qa4p vENr lNzz*92 /.Trto &E$s acVElFtP,L, XIA_ f\lt4t EATARD_ aLL,ae- -ftz yl wF oTtJtr;e. iTAtL'7', h IA L Lo h|t17a k owplJrxa €l Pa,poll 1b FJ TNALTFFTTD 2, BLvt, sg-,TlclN yglzlteu v B A ',//ELLT'lr. ?tt' li Fot irta I lr ll 1'b'tr exrcrtq Rlt riE- J-tpaE k=+acpeL f p>p6r1 Tt iauoSl7g ruF... Ea,e T: BLVD.gPR}NOFIELDI OFR . q1+1'/ Zxe yt*Tf?;as @ Zl"o,c.Erlt5Ttila PORLH ts-tg WEST w*l.L ortLY ?-zt c guTtl uttil- e ,4,,oP, O,n,L y15erl5Er.l fia b b>tc t>*u " @LuMNs itl ill HI lll It ll ll lr Aa,6b P5f Base ,al*cuers- ae wao) tf;r; .//za flrF zxb F57aEF1'g z4tt o,c, sflextah (z+/o) oNu rLyo lllll ltlli ( ,: ..:,. /zt'PLI'*ywz EYr6 6lTU TAP @ ,ri ilt ili )- extsrk EFE+I wAl'L T2 . DE FEMAVED ll pi P) R4b I t #t;fta fasncH l/2,t=lt-o', (.ll exnr'a, (prae. F2RoH NEW -[?*"H i ( CITY OF OREGO'U SPflIIllG .c, approval %ron!ng, and does not require specitic land use BI.^ECTRICAL PERHIT APPLICATION City Job Nunber -3. coHPLETE FEE ScEBDLILE BELov A Nev Residential-Single or MuIti-Family per dvelling unit. Service Included: I tems Cos t 1000 sq.ft. or less Each additional 500 sq. ft or portion thereo f Each Hanuf'd Home or Hodular DveIling Service or Feeder s 8s.00 s ls.00 s 40.00 Services or Feeders Installation, Alterations or Relocation: 225 FIFTE STREET SPRTNGPIEID, ORBGoN INSPECf,ION REOTIBST: OFFICE: 726'-3759 'glii1jy"6yl2,-a3 Authorized Signature C 1 OP 4 t)n0n LBGAL DESCRIPTION JOB 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 INSTALI.-ATION ONLY Sum B Electri Address si 0vners Name Address cal Contractor .0.200 amps o 201 amps t 401 amps t 601 amps t 0ver 1000 Reconnect r less to 400 amps -- o 600 amps _o 1000 amps_ amps/volts _0nIy 8 s s0.00 s 60.00 $100.00 s130.00 $300.00 $ 40.00 =" Ci Su prrone 141-7\13b pervi sor cense Nurnber rbsbs Expiration Date l0 - t - qs constr contr. Number 03841 Expiration Date iq - I -q+ of Supervising Electric Temporary Services or Feeders InstaIIation, Alteration or Relocalion 200 amps or less $ 40.00 201 amps to 400 amps - $ 55.00 over 4b1 to 600 amps - $ 80.00 Over 600 amps or 1000 voT[s see ttB'r a[6tE- c t Ci ty pnon" 441 -r1393 OSNER ALLATION The installation is being made on property I ovn vhich is not intended for sa1e, ]ease or rent. Onners Signature: Branch Circui ts Nev, Alteration or Extension Per PaneI One Circuit S 35.00 Each Addi tional Circui t or vi th Service or Feeder Permi t S 2.00 SUBTOTAL OP ABOVE 5Z State Surcharge TOTAL Miscellaneous (Service/feeder not inclr.rded) -Each instaLlation Pump or irrigation $ 40.00 Sign/Outline Lighting- S 40.00 Limited Energy/Res - $ 20.00 Limited Energy/Comm S 36.00 C E o 5 DATE: RBCEIVED SP,II'tGFIELD RESIDENTIAL PERMIT APPLICATION lnspections:726'3769 Olfice: 726-3759 LOCATION OF PROPOSED WORK: ASSESSORS MAP: LOT:/n qr, JoB NUMBE " ?3 a ; 225 Fifth Street Springfield, Oregon 97 477 d., TAX LOT: BLOCK:-SUBDIVISION STATE El-strryl,r .ry ZIP:e747 7 -T- CITY: ADDRESS: OWNER NEW -- FtEMoDEt t-/ ADDlrloN DEMoLISH orHER DESCRIBE WORK CONST. PHON ECONTRACTOR 'EXPIRESADDRESSCONTRACTOR'S NAME MECHANICAL: ELECTRICAL: GENERAL: PLUMBING l.^ t OCCY GROUP # OF BDRMS RANGE ZONING CODE: FLOOD PLAIN HEAT SOURCE: r OF UNITS: CONSTR. TYPE:r/ru # OF STORIES: -WATER HEATER: - _ OFFICE USE _ LAND USE: \tt I SECONDARY HEAT: SOUARE FOOTAGE: To request an inspection, you must call 726-3769. This is a 24 hour recording. All inspections requested before 7:00 a'm. wlll be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. REOUIRED INSPECTIONS Temporary Electric Rough Mechanical - Prior to cover. Final Plumbing - When all plumbing work is comPlete. Site lnspection - To be made after excavation, but Prior to setting forms. x Rough Electrical - Prior to Final Electrical - When all electrical work is complete.c o\ver Underslab Plumbing/ Electrical / Mechanical - Prior to cover.,K.Electrical Service - Must be approved to obtain llermanent electrical power. Final Mechanical - When all mechanical work is complete. x Footilrg - After trenches are excavated.Fireplace - Prior to facing materials and framing lnsP. ,K Final Building - When all required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting. ,X Framing - Prior to cover' Other Foundation - After forms are erected but prior to concrete placement.Wall/Ceiling lnsulalion - Prior to cover, Underground Plumbing - Prior to filling trench.Drywall - Prior to taping MOBlLE HOME INSPECTIONS Underlloor Plumbing/ Mechanical - Prior lo insulation or decking.Wood Stove - After installation. Post and Beam - Prior to floor insulation or decking. rtoor friiutation - Prior to decking. fl Blocking and Sel-Up - When all blocking is complete.lnserl - After fireplace approval and installation of unit. Plumbing Conneclions - When home has been connected to water and seiver. Sanitary Sewer - Prior to filling trench.Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. Storm Sewer - Prior to filling trench. Sidewalk & Driveway - Aftcr excavation is complete, forms and sub-base material in place. Fence - When completed.Water Line - Prior to filling trench.Final - After all required inspections are approved and porches, skirtlng, decks, and venting have been installed. Street Trees - When all required trees are planted. Rough Plumbing - Prior to cover. I PHoNE: 74/-ZZQS QUAD AREA:5 il &nt tl E E tl E E E tl E tlCurbcut & Approach - After fornrs are erected but lrrior to placement of concrete. Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type -. lnterior - Corner -- Panhandle - Cul-de-sac Setbacks PL.HSE GAR ACC N J ls-:-rlE PROPOSED WORK lN THE }lISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be signed and approved by the H istorical Coordinator prior to permit issuance. APPROVED:E 1 cwe BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is grantecl on the express condition that the said construclion shall, in all respects, conform to the Ordinance adopted by the City of Springfield, including the Development Cocle, regulating the construction and use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Hez_ Date Receipt Numbe Receivcd By: Plan Check Fee:,Zg VALUE UA'-( uuaefr 2,b{ P ao (A) 1.F BUILDING PERMIT z, tles Total Value Builcling Permit Fee State Surcharge Total Fee SQ. FT. X $/SQ. FT.ITEM Main Garage Carport 2GT Systems Dovelopment Charge is due on all undeveloped properties within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ADDITIONAL COMMENTS ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home PLUMBING PERMIT FEE N0 FT. FT. FT. (c) Plumbing Permit State Surcharge Total Charge Wood Stove/ lnsert/ Fi replace Unit Dryer Vent MECHANICAL PERMIT Mechanical Permit (D) N0 lssuance State Surcharge Total Permit Fu rnace Exhaust Hood Vent Fan By signature, I state and agree, that I have caref ully examined the completed application and do hereby certify that all information hereon is true and correct, and I f urther certify that any and all work performed shall be done in accordance with the Orclinances of the City of Springfield, and the Laws of the State of Oregon pertaining to the work described herein, ancl that NO OCCUPANCY will be made of any structure without perrnission 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 proiect. I f urther agree to ensure that all reguired inspections are requested at the proper time, that each address is readable f rom the street, that the permit card is located at the front of the property, and the aPProved Date -+- of co )(isnutu," durion the site at all ti plans will remain tion. MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk -. ft Curbcut -- ft Demolition State Surcharge Total Miscellaneous Permits (E) I ^tDATE PAID q3 AMOUNT RE,CEIVED RECEIVED AY -- VALIDATION: RECEIPT NUMBER .>{ TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) gu-z{ Date Paid: /y''Z- ?-