HomeMy WebLinkAboutPermit Building 1991-10-09eg9eo
BLOCK:LOT:
TAX LOT:
SUBDIVISION
JOB NUMBER
LOCATION OF PROPOSED WOBK:
ASSESSORS MAP:
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Otfice:726-3759
225 Fifth Street
Spri ngfield, Oregon 97 477
- '-?3/nPHONE:
ZIP:OKSTATE:
,{ I
CITY:
ADDRESS
OWNER:
NEW
-
REMODEL ADDITION DEMOLISH OTHE
DESCRIBE WORK:
EXPIRES PHONEADDRESSp2,CONTRACTOR'S NAME
MECHANICAL:
ELECTRICAL
CONST.
CONTRACTOR #
GENERAL:
PLUMBING
RANGE:
# OF BDRMS
_ OFFICE USE _
LAND USE:
ZONING CODE:
FLOOD PLAIN
WATER HEATER
r OF UNITS:
SECONDARY HEAT:
SQUARE FOOTAGE:
QUAD AREA:
* OF BLDGS:
OCCY GROUPT
# OF STORIES
To request an inspection, you must call 726-3769. This is a24hour 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.
REQUIRED INSPECTIONS
l--l Temporary Electric Final Plumbing - When all
plumbing work is complete.
Site lnspection - To be made
after excavation, but prior to
setting forms.
Rough Electrical - Prior to Final Electrical - When all
electrical work is complete.cover
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.
Electrical Service - Must be
approved to obtain permanent
electrical power.
Final Mechanical - When all
mechanical work is complete.
Footing - After trenches are
excavated.E Fireplace - Prior to facing
materials and framing lnsp.
E Final Building - When all
required inspections have been
approved and building is
completed.Masonry - Steel location, bond
beams, grouting.
OtherFoundation - After forms are
erected but prior to concrete
placement.Wall/Ceiling lnsulation - Prior to
cover.
Underground Plumbing - Prior
to filling trench.Drywall - Prior to taping
MOBILE HOME INSPE TIONS
Underlloor Plumbing / Mechanical
- Prior to insulation or decking.Wood Stove - After installation
Post and Beam - Prior to floor
insulation or decking.lnsert - After fireplace approval
and installation of unit.
Blocking and Set-Up - When all
blocki ng is complete.
Floor lnsulation - Prior to
decki ng.Curbcut & Approach - 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
tren c h.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 - After
excavation is complete, forms
and sub-base material in place.
Water Line - Prior to filling
trench.
Fence - When completed.
Street Trees - When all required
trees are planted.
Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.
Rough Plumbing - Prior to
cover.
/.1</, ,O/eas*or
1-i: 7
CONSTR. TYPE:
HEAT SOURCE:
[-l Rough Mechanical - Prior toU cover.r
E
r
E
r
E
E
E
E
E
E
E
I Framing - Prior to cover.
t]E
Lot faces
Lot sq. ftg.
Lot coverage
TopograPhY
Total height
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
PL.HSE GAR ACC
N
S
E
VALUE
/5.7s(A)
AD
X S/SQ. FT.
,7s
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carport
( ?qt?o
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.
Receipt Number:-
Plans Reviewed By Date
Plan Check Fee:
Date Paid
Received By
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ITEM
Fixtu res
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
(c)
FT.
FT.
FT.
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Fireplace Unit
Dryer Vent
(D)
N0Vent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rnace
Exhaust Hood 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 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 f urther 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 during construction.
Signature
Date o-
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
I Miscellaneous PermitsTO (E)
Su rc harge
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
7s
10 7-?/
77 t-
2t5.7 &
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
VALIDATION:
RECEIPT NUMBER
, THE PROPOSED WORK I N THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this application must be signed
and approved bY the Historical
Coordinator prior to permit issuance.
APPROVED:
N0
/3
Permit No:
Address:
lssued bY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS. -ABOUf
CONSTNUCTION RESPONSIBILITIES
Fill in the applicable blanks, and initial box 1 and either box 2A or 28:
1. t---l I own, reside in, or will reside in the completed structure'
2. AEI-MY general contractor is
Note: oregon Law, oRS 701.055(4), requires residertial building-permit applicants
*no "i"-iot regi6Gred with tne'Coirstruction Contractors Board to sign. the
following statemenioeiore the building permit can be issued. Licensed Architect
"no
engin"., "ppiit""ii, "*9.pt frori iregistration under oRS 701'010(7), need
not submit this statemeht. Thii statement will be filed with the permit.
2
*
<u
,/I Date: /C -.1*7' /
/
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure musf be registered with the Construction Contractors Board.
OR
B I will be my own general contractor.
lf I hire subcontractors. I will hire only subcontractors reoistered with the
Construction Contractors Board. lf I chanoe my mind and llo hire a oeneral
contractor. lwill contract with a contrattor-who is reoistered w-ith the
Constructibn Contractors Board and I will immediately-notify the office
issuing this building permit of the name of the contradtor.
.l
I hereby certify that the above information is correct and that I have read and understandthe lnformation Notice to Property Owners about Construction Responsibitities on thereverse side of this form.
Si gnature of Perm pplicant Date
WHITE COpy TO tssutNc AGENCY pERMtT F|LEPINK COPY TO APPLICANT
GONSTRUCTION @NTRACTORS BOARD
0244J 10t24t89
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