HomeMy WebLinkAboutPermit Building 1993-04-08ELO
RESIDENTIAL
PERMIT APPLICATION
lns pections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:
LOT
-
BLOCK:
q31 55)
?fr,
JOB NUMBER
225 Fifth Street
Sprl ngfield, Oregon 97 477
TAX LOT:
SUBDIVISION:
f,
,-OWNER PHONE
CITY:ZIP:
)
\STATE:(-l$.t
, O, -Bc,r- -?O'tz-ADDRES
<ta -,, Cl -D V\-\
ADD ON
-
DEMOLISH OTHER
DESCRIBE WORK:
NEW )( BEMODEL
PLUMBING:
ELECTRIOAL:
ADDRESS
CONST.
q 2 m.
MECHANICAL:
CONTRACTOR'S NAME
G EN ERAL:
USE -
AC,
\
$uu( ,- OFFICE
LAND USE:
WATER HEATER:
ZONING CODE:
FLOOD PLAIN
* OF UNITS:
SECONDARY HEAT:
SQUARE FOOTAGE:
# OF BDRMS:
-
QUAD AREA:
* OF BLDGS:
OCCY GROUP:
* OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
\\
To request an inspection, you must call 726-3769. Thls ls a 24 hour recording. All inspections requested before 7:00 a.m. will be
made the same worklng day, lnspections requested after 7:00 a.m. will be rnade the following work day.
REQUIRED INSPECTIONS
|_-l Temporary Eleclric Rough Mechanical - Prior to
cover.
Final Plumbing - When all
plumbing work is complete.
Site lnspeclion - To be made
after excavation, but prior to
setting forms.
Rough Electrical - Prior to Final Electrical - When all
electrical work is complete.cover.
Underslab Plumblng / Electrlcal /
Mechanical - Prior to cover.
Electrical Servlce - Must be
approved to obtain permanent
electrlcal power.
Final Mechanical - When all
mechanical work is complete.
Footing - After trenches are X Final Building - When all
required inspections have been
approved and building is
completed.
Fireplace - Prlor to faclng
materlals and framlng lnsp.
Masonry - Steel location, bond
beams, grouting.]Vf framtng - Prior to cover.)4XFoundation - After forms are
erected but prior to concrete
placement.
Other
Wall/Ceiling lnsutation - Prior to
cover.
Underground Plumbing - Prior
to filling trench.l--l Drywall - Prlor to taplng.
MOBILE HOME INSPEGTIONSUnderlloor Plumbing/ Mechanical
- Prior to insulation or decking.Wood Stove - After installation
Posl and Beam - Prior to floor
insulation or decking.lnsert - After flreplace approval
and lnstallation of unit.
Blocking and Set.Up - When all
blocking is complete.
Floor lnsulation - Prior to
decking.Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Plumbing Connections - When
home has been connected to
water and sewer.
aSanitary Sewer - Prior to fllllng
trench.Electrical Connection - When
blocking, set-up, and plumblng
inspections have been approved
and the home ls connected to
the service panel.
Storm Sewer - Prior to filling
trench.
n Sidewalk & Drlveway - After
-
excavation is complete, forms
and sub-base material ln place.
Water Llne - Prlor to filling
trench.
Fence - When completed.
Rough Plumbing - Prior to
cover.
Slreet Trees - When all required
trees are planted.
Final - After all required
inspections are approved and
porches, skirtlng, decks, and
venting have been installed.
X
lAoz- 7Z 3 I
RANGE:
E
tl
E
fl E
Lot faces
Lot sq. ftg.
Lot coverage
TopographY
Total height
Lot Typev
\7
'n lnterior
-
Corner
-
Panhandle
l-de-sac
(.._IS THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTEFI?
-
lf yes, this application must be signed
and approved bY the Historical
Coordinator prior to permit issuance.
APPROVED:1
P.L.HSE GAR ACC
N
S
E
on the express condition that the said
all respects, conform to the Ordinance
2@.
P ewe dBv
Recei pt Numbe
U-BUILDING
perm--iltsglanted
ofS
2
E, PLAN CHECK
PERMIT
BUILDING VALU
This
construction s
Received
or revoked at any tiniebulldings, and maY be susP
ord i nances.upon violation of anY Provisions
Plan Check Fee:
Date Paid
adopted by the
Development Code, regul
X:**te r#
? 3/ 552
pringfield, including the
the construction and use of
BUILDING PERMIT.'
VALUE
G7Z _CZEZA
65, /.3(A)
SQ. FT, X $/SQ. FT,.ITEM
Main
Garage
Carport
Total Value
Building Permlt Fee
state surcharge
Total Fee
Systems Development Charge is due on all undeveloped
properties withln the City limits which are being improved.SYSTEMS DEVELOPMENT CH
(B)IARGE
ADDITTONAL COMMENTS
ITEM
Flxtures
Resldential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
FEE
4 A-aQ
,1s
-tZS-/-(a '(c)
N0
FT.
FT.
Plumbing Permit
State Surcharge
Total Charge
Wood Stove/ lnsert/ Fi replace Unit
Dryer Vent
(D)
N0Vent Fan
Mechanical Permlt
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rn ace
Exhaust Hood
By slgnature, I state and agree, that I have carefully examined
the completed application and do hereby certify that all
lnformation hereon is true and correct, and I f urther certify
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 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 certlfy that only contractors and employees who
are ln compliance 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 permlt card ls located at the front
of the property, and the approved set of plans will remain
on the slte at al imes duri
Date
gnatu
nstruction.
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sldewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
Z
G4
e
>/
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, Q and E Combined)
GZ'O
3,13
PLUMBING PERMIT
Fr. <ao'
BACKFLOI^I PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING, SAFETY DIVISION
SPrlINGFlELE,
Offi ce:
INSPECTION LINE:
726-3759
726-37 69225 F'ifth Street
Springfield, Oregon 97 477
Job Locat'ion :
Asses
Address:
City:State:
Backflow Permit is $15.0 0 + $0.75 State Surcharge
Contractor:
Address:
City:State:
#Tax Lot #:
Phone #:
Z1 p:
+nqb'g\d^^,)
Phone #:
Zi p:
Constrriition Contractors Registration #:
gna ture
i res:
By signing this permit/application, I agr99 to call for an inspect'ion once the
backftow prernntli;';;;;tt h;; Ueen insla]1ed and is visib'le for inspection
(726-3769). r aiio i[ate that aii info"rution on this app'lication/permit is
correct.
uate
Date of ApPiication:
Rece'ipt #:
FOR OFFICE USE
Issued By:
tlob #:
Tota'l Amount Col I ected:
1l/90 REgIDENTIAL - COYIYIERCIAL
gIDEIUALK / CURBCI,IT
APPLICATIOT.] / PEtr1IT
SPFlINGF!ELO
225 NORTI] FIFTI-.I gTREET
SFRll.lC,F IELD, ORE6OI{ 314'1'1
El.lc INEER|NG D tvr I tor.{
ffitcE No. 126-31b7
IN5PECTIoN LINE,'126-3'163
JoB ADDRES9: 2t5 n Sr"",{ l... Loo'
*'A99E99OR5 F1AP NO.TAX LOT NO.
9lBDtVl9loN,
RECEIPT NO:
cA9+{
tLOt4
CHECK ,/ iL 38 ZD
*
CHECKED FOR DELNAJENCIEg
I
SIGNED:
DATET
OtLh,lER,J"S^lli.r.",
ADDREee; lz{S At\c.,
STATE,o(7 7lF.
IIJOFK t6l,
SIDEIIALK:CURts SIDE
UJoFK TO tsE rERt=qqrEp gr,
CON;RACTOR*
CllYt
PHohrE No. *7 zL-i
SETBACK
-
col'1}-tERlcAL _
orrlER
6
LUl<=-L.iJ l:=5tDEl.,iTtAL _
9ECOND DRI\TEIIJAY ( 5EE TRAFFIC )I/
EAUIREg APPLICATIOI{ FOR A *COND DR 6UJAY(T-4.Ia)
OR A cAdNTY AFPLICATION FOR FACILITY PER1IT (C Ab.2O3)
IF IN THE UG.B.
DATE OF APPLICATION 0
COI.,ITRACTOR
xREGISTRATION NO.EXPiRES,
ADDE53 Pi-iONE'
PROCEDURE FOR IN9FECTICil REAUE9T:
CALL 12b.316A (FSC(,FOER ) STATE YOIJR CITY DEgIGNAT=D JO3 NLJ|.13=R, JO3 ADDEggJYPE 6
lNgPEcTlohl REaUESTED r'J.{D tlr.{EN YoU UJILL B= READY FoR lNgPEcTlOl.i, cohlTRACToRg OR oLlh{ERg N4]'1= l'].{D
P|]OhIE NLJIIEER R=AU=9T9 R=CEIV€D BEFORE lOO N UJILL BE I.1ADE TiIE 9r'JiE DAY, REAUESTS #TE?1IO@
r'f,1U,IILL BE HADE THE NEXT IIJOR<ING DAY
EXIgTINIG tsUILDIN6 PER-IIT NO. ( IF APPL
*gEE BOOK Y *
gIDEIUALK / DRI\GUJAY
rcR ALL CONCRETE PAVING IUITHIN
THE 9TE,ET RICHT OF IIJAY, TO 3E
HADE AFIER ALL EXCAVATING
15 COMPLETE AID FOB1 uJOR<
AND sUB.BA5= HATERIAL 19
IN PLACE
CU@ / APFROACI..I APROI!:
AFTER FOg15 ARE ERECTED
BUT PRIO TO POURING
CONCR=TE.
FEE9, SIDEIUALK5 CURB-CUT IIJALK X,
jlO.OO + IO.1>/LF.( X )
OF IUALK
ilO.OO + tO.l>/LF.( X )
TOTA FEFI"IIT FEE'
CO|.IMERICAL DRI\EIUAY9 gI]ALL
HAVE 5' TO A'FLAIRg
3'. A- STADARD
I AAIF, CAREFL'LLY EXAYINED TI-]E COI'IPLETED APPLICATIC'|.I FOR PER-IIT, AND DO HEREBY CERTIFY TI-]AT ALL
INTRHATICII |.{EREON l5 TRIE A\D CoRR=cT, A\D I FURTH=R CERTIFY'irlAT ANY AND ALL tlioR< PERFOR'1ED
gI..{ALL BE DONE IN ACCORDANCE IUITH TI{E ORDINANCES G THE CITY 4 SPRING,FIELD, AID 11-19 IAI]Jg OF THE
gTATE G OREGON PERTAINING TO
OF ANY STRJCTURE IUITI-.IOJT PEB1I
TI{E }IEREIN, AND TI-{AT NO OCCUPANCY UJILL BE IIAD=
tsUILDINC DI\/ISION I FURTHER CERTIFY THAT ONLY CONTRACTORg
O?5 1@1@>> uJILL 3E USED ON TI1I5 FROJECT.
I E x'
Z?
UJ+]O ARE IN
r39rorl
DATE
)
EAUIRED IN9PECTICI.IS
iln/q4
-7{IC'-
APPLICATION FOR A SECOND DRIVEIIAY
DATE: S^)o-'if
APPLTCANT (PROPERTY OlrNER) :
ADDRESS OF APPLICANT:
L
ADDRESS OF PROPERTY FOR 2ND DRIVEUAY:
APPLICANT'S TELEPHONE NO. :
It-,,&,7o2 2_
779- q73'Z ,11 '7 Zi^ -)Q 6 3 ,brcs','ruZ..ti
ield that are vithin the
The following conditions must be ansvered affirmatively in order for this
application to be considered for approval:
1). Property is either a single family residence or duplex.
YES\T NO1-
2). The proposed drivevay vill take direct access from a minor street' (not-a tollector or arterial street). YESY N0
-.3). The drivevay vill have a minimum setback of 30 feet from the curb
return of an intersection (for corner lots). YES V NO-'
t'
4). The proposed drivevay (parking area) must have a minimum depth of
18 flet-betveen the front property line and the garage, carportt
fence oy'vall, if any (identical to setback for garage)'
'IES L/: No_.
5). The second drivevay mgst have direct access to a garage' carport,
rear yard or the {i$yard vhere the vehicle, trailer or boat vill
be stored. yES / N0_.
6). If the vehicle, trailer or boat is to be parked/stored in the side
yard, there must be a minimum setback of 5 feet betveen the stored
vehicle and the side property line. This setback is for fire
. fighting access and to comply vith the ipgent_of the zoning code.
Setback satisfied? YES- N0-. N' fT
7). The proposed parking/sto.rage area must not create arvision -obstruction to adjacent property drivevays or to 98, vehicular
movement on a public street. satisfied? 'IES l// N0_.
This application shall include an 8 7/2't x 11rr draving-shoving existing
drivevays, and the proposed drivevay. Please include dimensions, and
measurements to road intersections and/or bordering drivevays.
Att applications outside the city limits of Springf
Urban Gnovth Boundary require a Lane County permit'
Applicant hereby agrees to install the requested drivevay to City of Springfield
stindards. The applicant further agrees to have 6rrof concrete in the sidevalk
area adjacent to the proposed drivevay and further agrees to pave the area
behind ihe back edge of the sidevalk, or drivevay aPron' adjacent to the
drivevay vith a minimum depth of 3" of asphaltic concrete or vith a minimum
depth of 6'r of portland cement concrete. The area behind the sidevalk shall be
paved to the property line or for a distance of 4 feet vhich ever is greater.
The applicant agrees that if he/she does not pave the area behind the sidevalk
vithin 30 days of cutting the curb opening, the City of Springfield has the
authority of close the drivevay access by the removal of the curb cut. AIl
incurred costs shall be assumed by the applicant and if unpaid, said cost shall
become a lien of the property.
Lrhen this application is approved by the City, the applicant (property ovner)
must obtain a drivevay permit from the Public I{orks Department Engineering
Division.
PERMIT FEE
0n an improved street (existing curb):
$10.00 plus $.15 per linea1 foot of curb cut.
0n an unimproved street (not curbed): S12.00
0n currently unimproved streets that are under construction:
s12.00.
PROPERTY OWNER'S SIGNATIJRB:
DATE:
a
b
c
C)
APPROVED BY:
DATE:
BUILDING PERMIT NO.:
DATE:
TRA 9-1
ATTACHMENT:City o
Dated
C
?q953
fsp
L0/8
ringfield Standard Draving No. 3-11
/82
t
iI
t
)
,oB No. 1b t55V
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
I.JORKSHEET
(C0MMERCIAL & RESIDENTIAL)
NAME OR COMPANY:Surur (*N
LOCATION:? t5 - 2-1'l t1-t-1 t--P /70772?t - I 9t o
DEVELOPMENT TYPE:ttAnz - Lr>r> C**Coer
BUILDING SIZE:
I. STORM DRAINAGE
TMPERVToUS SQ. FT.
2. SANITARY SEt,lER-CITY
NO. OF PFU'S
(See Reverse)
3
siz
ZZ4 x $0.203 PER SQ. FT.
X $42.08 PER PFU
. Ft.
TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRiP
4. SANITARY SEWER-MWMC
NO. OF PFU'S
$
$
$I5.125 PER PFU + $iO Mt,lMC ADM FEE $
TOTAL-MWMC SDC
SUBT0TAL (ADD ITEMS 1,2,3 & 4)
x-x $424.31
x $424.31
x $424.31
X
x
(Use PFU Total From ltem 2 Above)
I4t.lMC CREDIT IF APPLICABLE (SEE REVERSE)
5 ADMINISTRATIVE FEES
BASE CHARGE (SUBToTAL ABoVE) X .05
- Kip Burdick
SDC Coordinator
a 7A
TOTAL SDC
t4s 41 >
,o aC'TY OF
225 PIFTE SATEEf,BLECTRICAL PERHIT APPLICATION
q3- /553
IAGAL DESCRIPTION'^ ^-?i2-7/ 2 ->
-
JOB DESCRIPTION
Wt-t<tt ,i Zol"r.f
-
Permits are non-transferable and expirelf vork ls not started vithin 180 daysof lssuance or if vork ls suspended for
180 days.
2. CO}TTRACTOR INSTALI,ATION ONLY
Electrlcal Contractor
Address
Phone 4,fr1-O%5
Supervlsor License Ndmber /%SZ<-
Explratlon Date /d= / - qi
Constr Contr. Number 541/3,/
Expi ration Date
Slgnature ing Blectrician
/:t?
0vners Name
Address
ct Phone
OSNER INSTALI,ATION
The installatlon is being made on
property I ovn vhich is not intendedfor sale, Iease or rent.
0vners Signature:
DATE:
RBCBIPT t:
BELOV
eor
Iing unit,
Service fncluded:Items Cost Sum
7 g 85.00 /7t1",
Z $ 15.00 -iO re
g 40.00
$ s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
i, !i,
-4=-
'? /a g4
B
1000 sq.ft. or less
Each additional 500
sq. ft or portion
t hereo f
Each Hanuf,d Home or
Modular Dwelling
Service or Feeder
Services or Feeders
Installation, Alterations or
Reloca t ion:
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps _601 amps to 1000 amps_
Over 1000 amps/volts
Reconnect 0nly
SIIBTOTAL OP ABOVB
5Z State Surcharge
TOTAL
C. Temporary Services or Feeders
Installation, Alteration or Relocation
above
D. Branch Circuits
Nev, Alteration or Extension Per Panel
One Circult $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E. Miscellaneous (Servlce/feeder not included)
-Each installation
Pump or irrigation
Sign/outline Lighting-
Limi ted Energy/Res
Limi ted Energy/Comm
zla '9
200 amps or less $ 40.00
2ot amps to 400 amps
-
$ 55.00
Over 401 to 600 amps _ $ 80.00
Over 600 amps or 1000 volts see rrBrl
00
00
00
00
$40
$40
$20
s36
5
RECEIVED
1/--a -?7
1. IOCATION OF
crrv E/o*<
c
ST'NI1\lGFIELD
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759 qr,
J N MB
5Fi
Springf ield, Oregon 97 477
h
t
LOCATION OF PROPOSED WORK:
ASSESSORS MAP: /?+7?z -?,"
u
L,-
TAX LOT:e-ZD
BLOCK: , -SUBDIVISIONLOT
--PHONE
?2?ZIP:STATE: -
Z,Vr
e?2-
CITY:
ADDRESS:
OWNER:
ADDITION DEMOLISH OTHER
DESCRIBE WORK
NEW-- REMODEL
PHONEEXPI RESADDRESSCONTRACTOR'S NAME
MECHANICAL
ELECTRICAL:
CONST.
CONTRACTOR #
GENERAL:
PLUMBING
SRtut-
U
WATER HEATER:
_ OFFICE USE _
# OF BDRMS
RANGE
OCCY GROUP:
, OF STORIES
OUAD AREA:
# OF BLDGS
SECONDARY HEAT:
SOUARE FOOTAGE:
FLOOD PLAIN:
ZONING CODE
CONSTR. TYPE
HEAT SOURCE:
LAND USE:
# OF UNITS
To request an inspection, you must call 726-3769. This is a 24 hour record ing. All inspections requested before 7:00 a.m' will be
made the same working day, lnspections requested after 7:00 a.m. will be made the following work day'
REQUIRED INSPECTIONS
[l femporary Electric Rough Mechanical - Prior to
cover.w
tr
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.c ove r.
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.V)Electrical Service - Must be
approved to obtain Pcrmanent
electrical power.
Final Mechanical - When all
mechanical work is comPlete.
Footing - After trenches are
excavated.Fireplace - Prlor to facing
materials and framing lnsP.
w Final Building - When all
required insPections have been
approved and building is
completed.Masonry - Steel location, bond
beams, grouting.8
q
V
Framing - Prior to cover
Other
Foundalion - 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
W
w
q
a
a
a
fr
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.Wood Stove - After installation
Post and Beam - Prior to floor
insulation or decki ng.lnsert - After f ireplace approval
and installation of unit.
Blocking and Set'UP - When all
blocking is comPlete.
Floor lnsulation - Prior to
deckitt g.q Curbcut & APProach - Af ter
forms are erected but Prior to
placement of concrete.
Plumbing Connections - When
home has been connected to
water and sewer.
Sanitary Sewer - Prior to f illing
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.
s4 Sidewalk & DrivewaY - Aftcr
excavation is comPlete, fornls
and sub-base material in Place.
Fence - When comPleted'Water Line - Prior to filling
trench.u
ffi
Final - After all required
inspections are aPProved and
porches, skirtlng, decks, and
ventinO have been installed.Street Trees - When all required
trees are Planted.
Rough Plumbing - Prior to
cover.
t
q
a
E
E
E
tl
tl
n
E
tl
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type
-_
lnterior
-
Corner
--_ Panhandle
-
Cul-de-sac
Sctbacl<s
P.L.HSE ACCGAR
N
IS-THE PROPOSED WOHK IN THE
}IISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTEB?
-
lf yes, this application must be signed
and approved by the H istorical
Coordinator prior to permit issuance.
APPROVED:
S
E
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This pcrmit is gr;rnt(]d on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted t:y the City of Springfield, including the
Develolrrnt-.r.rt Corlc, regulating the construction and use of
buildinpls, ;rnrj nray bo suspended or revoked at any time
- upon violation of any provisions of said ordinances.
Plan Check Fee: ..._-
Plans Reviewed By Date
Date Paid
Receipt Number:-
Fleceived By
/fz1*i €rrqr-rr' -@-
VALUE
(A)
X $/SQ. FT.
Total Value
Building Permit Fee
State Surcharge
Total Fee
/rc,r>_
2-42
//2.*
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carport
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ITEM
Fixtures
Flesidential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Homehrr*/to@n.q+ _/5?,
FEE
N' Z.< Z
FT.
FT.
(c)
PLUMBING PERMIT
fia.n
_2925
--za-?
7D.,4
Plumbing Permit
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Fi replace Unit
Dryer Vent
,/2
(D)
N0
2/
Vent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
__ 1.€
Ve"ef
MECHANICAL PERMIT
Fu rn ace
Exhaust Hood By signature, I statc 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 Statc of Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Divlsion.
I f urther 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
requesled at the proper time, that each address is readable
from the street, that the permlt card ls located at the front
of the property, and the approved set of plans will remain
Signature
Date
on the site at times during c truction
MISCELLANEOUS PERMITS
Mobile Home
StatiT lssuance
State Surcharge
Sidewalk f t
Curbcut
-
ft
Total Miscellaneous Permits -5:(E)%--z
/2a:_
/l-ft
Demolition
State Surcharge
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
-'-=>-5rDATE PAID
VALIDATION:
RECEIPT NUMBER
AMOUNT RECEIVED
RECEIVL..D I]Y -
1
FT.
57?,ry