HomeMy WebLinkAboutPermit Mechanical 1992-09-28SPRINGFIELI)
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oge3JOB NUMBER
LOCATION OF PROPOSED WORK:----
rAX Lor: - *OO1l5 -ASSESSORS MAP:
LOT:
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Of fice: 726-3759
225 Fif th Street
Spri ngf ielcl, Oregon 97 47 7
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OWNER: --.
orY:
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ADDRESS: - -5-]
NEW
-_
FIEMODEL ADDITION DEMOLISI1 OTI-IER
DESCRIBE WORI(:
ELECTRICAL:
EXPIRES P}-IONEADDRESS
rrrJffi-
CONTRACTOR'S NAME.
MECHANICAL:
CONSI.
CONTHACIOI] #
GENERAL:
PLUMBING
FLOOD PLAIN:
-_
ZONING CODE:
--.# OF BDRMS: - -. -
SECONDARY HEAI:
SOUAI]E FOOIAGE:WATER HEATER:
/i OF STORIES:HEAT SOURCt.:
QUAD AREA:
CONSTR.TYf']E: --.
s OF UNITS: - -,-
- OFFICE USE _
LAND USE:
RANGE:
-
OCCY GROUP: - --
To request an inspection, you must call 726-376g. This is a 24 hour recording. All inspections requested before /:oo a.m. will be
rnade the same working day, inspectlons requested after 7:00 a.m. will be nracle tlrc [r')llowirlg work day'
REOUIRED INSPECTIONS
l-l Temporary Electric
ll
Rough Mechanical - Prior to
cover.l-l Final Plunrbing - Wtren all
plurrrbing work is cotnPlete.
Site lnspection - To be made
after excavation, but Prior to
setting forms.
Rough Eleclrical - Prior to
t_ _l Final Electrical - Wlren all
electrical work is cornPlete.cover.
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.
Electrical Service - Must bt:
approved to obtairr Permanont
electrical powcr.
Final Mecharrical .- When all
mechanical work is comPlete.
Fooling - After trenches are
excavated.Fireplace - Prior 1o facing
rnaterials ancl f ratning lnsP'
Final Building - When all
required inspections have been
approved and building is
colnpleted.Masonry - Steel location, bond
beams, groutin-q.Framing - Ptior to covcr,
Foundation - After forms are
erected but Prior to concrete
placement.
[] otner
Wall/Ceilinl; lrrsulation - [)tiot tcr
cover.
Underground Plumbilrg - Prior
to f illing trench.f-l Drywall - Prior to taning
MOBTLE HOME INSPECTIONS
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.Wood Stove - Af tcr irtstall;tliott
Posl and Beam - Prior to floor
insulation or decking.
t_J Blocking and Set'UP - Wlten all
blocking ls cornPlete.lnserl - Af ter {ircplace approval
and installation of unit.
Ftoor lnsulation - Prior to
decki ng.Curbcut & APProach - A{ter
forms are erected but Prior to
placement of concrete.
L]Plumbing Connections - Wlten
home has been connected to
water and sewer.
Sanitary Sewer - Prior to f illing
trench.I'-'l Electrical Conneclion - WhenU blocking, set'uP, and Plurnbing
inspections have been aPProved
and the home is connected to
the service panel.
Siclewalk & DrivewaY - A{ter
excavation is comPlete, {<.rrtns
and sub-base material in Placr-'.
Water Line - Prior to filling
trench.
[*-] Fence - Wlren conrPleted
Final - After all required
inspections are aPProved and
porchcs, skirting, clecks, and
venting have been installed.Slreel Trees - Wherr all reqtlir'r(l
trees are Planted.
Rough Plumbing - Prior to
cover.
Qs
r
I
Storm Sewer - Prior to filling
trench.
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l.ot flir:t::;
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[-ot oovcra!]e
Iir pog r:i J>Ity
Total height
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. Pattllrttcile
C) tr l -<l r:':;:tc
flcltrrr;ks
CAR
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ISJ', ,: PROPOSED WORK IN THE
IlIS'TOFIICAL DISTRICT, OR ON
THE HISTORICAL REGISTER? =-_,-
lf yes, this application must be signed
and approved by the Historical
Coordinator prior to perlnit issuance.
APPROVT-:D:
S
t:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition thilt the said
construction shall, in all respects, conform to the Orrjinance
adopted by the City of Springfield, including the
Developrnent Cocle, regulating the conslruction ancJ use of
buildings, and may be suspended or revol<ed at any lirne
upon viol.rtion of any provisions of said ordinances.
DalcPlarns [leviewecl By
Plan Check Fee:
Date Paid
Flccei pt Number:
Rccoived Ry:
VALUE
(A)
x $/so. l''T.
PERMIT
SO. FT.
BUILDING
ITEM
Main
Garage
Carport
Total Value
Bullding Permit Fee
State Surcharge
Total Fee
Systems Development Charge is due on all undeveloped
properties withln the City limits which are being improved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
Residential Bath(s)
Sanitary Sewt--r
Water
Storm Sewer
Mobile Home
PERMIT
FEE
NU
t'T.
FT,
(c)
PLUMBING
ITEM
Fixtu res
Plumbing Perrrtit
state surcharge
Total Charge
Wood Stove/ lnsert / Fireplace Unit
Dryer Vent
(D)
N0Vent Fan
Meclranical Pertnit
I SSU anC(j
Slate Surcllar0r-.
Total Permit
l_E-o_o_
laoo_
_?ses"5
MECHANICAL PERM!T
Fu rnace
Exhaust Hoo(,By signature, I state and agree, that I have caref ully examined
the completed application and clo 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
wlth the Ordinances of the City of Springf ield, and the Laws
of the State of Oregon pertaining to the work described
hcrein, ancl that NO OCCUPANCY will l-:e 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
proiect.
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
Signature
Date
tr tion.
roved set of plarns will renrainpro pe r ly,of tlre
on the
MISCELLANEOUS PERMITS
Motrile l-lotrre
State lssuance
State Surcltarge
Sidewalk .. ft
Curbcrrt -, ft
f)cmolitiorr
State., Surclratl;t:
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrit:irl) teS-?S
VALIDATION:
RECEIPT NUMBER
-DATE PAID
b1)b
912\LqL
AMOUNT RECEIVED 2q ,s
FIECL,IVED BY.-,(A, R, C, D, ;rncl E Cotrtbined)\AE
AC(jt:lSE
f-T.-
OREGO'UOF
S'"IIN(;FtELT'
225 FIFTB STREET
SPRINGFIELD, OREGON 97477
INSPECTI0N REQUESTT 726-3769
OFPICE: 726-3759
1 LOCATION OF INSTALI^ATION1'1L< V"lu,
uee
ELBCTRICAL PERHIT APPLICATION
SCEEDULB BELOV
A. Nev Residential-Single or
HuIti-FamiIy per dvelling unit.
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dr.,elling
Service or Feeder
$ 8s.00
$ 1s.00
$ 40.00
B. Services or Feeders
Insta}lation, Alterations or
Relocation:
D. Branch Circuits
New, Alteration or Extension Per Pane}
t s 3s.oo W
-[he
ZQlt
0b
t- ,., i' ,-
'4
ir.rthorized
r7ffrybj'-{if IF1
PTI
JOB DES(N,IPTION
f,-'tl>i;' t\iJ.tw*t{
Permits are non-transferable and expire
if vork is not started vlthin 180 days
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTALT.ATION ONIY
Electrical Contrac r.or D l]Kt N ?IEIPI(_
Address 34 l40 F)
ciry f. Vhe[e-. Phone
Sum
)
Supervisor License Ndmber eh+S
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps _601 amps to 1000 amps_
Over 1000 amps/volts
Reconnect Only
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
-0ver 401 to 600 amps _Over 600 amps or 1000 volt
$ s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
Expiration oate [0 :]-qL
Constr Contr. Number q4
Expiration Date fJ-'7b -q' )
Signature of Supervising Electrician
Ovners
Address
c
$ 40.00
$ ss.00
$ 80.00
s see rrBrr
citv &A.Ld*'Phone
One Ci rcui t
Each Additional
aEove
ML,#J'irr;*o*Circuit or vith Service
or Feeder Permit 7 $ 2.00
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
0wners Signature:
DATE:
RECEIPT *:
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Out1ine Lighting-
Limi ted Energy/Res
Limi ted Energy/Comm
SUBTOTAL OP ABOVE
5Z State Surcharge
TOTAL
$ 40.00
$ 40.00
s 20.00
s 36.00
5
RECBIVED BY:
.L
ae\
city Job *u v", ?30'/4-1
-,
1
-;12
4)
oT/
25 AdditbEl lEIorution bY
lf yc. who will iautigte
E onl oa bccl
q
DO NOT STITE IN TTIIS SPACE
CONTROL ExPNO. NO
Districr of lncident
! INCIDENTADDRESS
s OCCUPANTIiAME(I.gI.
{ BUSINESSOWNERNAME Fint.
5 OWNERNAME (IaLFiEL MI)
6 FIRE REPOFTED B1' (ksL Firt
Telephone Direa
ALARM fl M*iapda"-s"",.
El Privae .llam Slstem
8#PERSONNEL
RESPONDED
9 TYPEOFSITUATIONFOUNDE/s**r*
:.= ;'.- -_ _ I._ '^ -_'-....,
S T ATE.-O{''OREC9N FIRE B3 PORT
STATE FIRE I\I,TRSEAL
Radio
Verical
911 (Tie Line)
Voie Sigal Mui Alam
D No.ch-n "'d E NotClareifiedAbove
E oto rl.i"tt
E McterStruDevia
E NotClasifiedAbove
FIRE DEPT
ALARM NO,
Bclow lwel
Not Clasified
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OF S€lf-Ertin3uished
D(TI}IGUiSHMENT fl Male-shnaids
1I FD(EDPROPERTI'USE
f] AmruticExt.Svm
EfP--*oom h*lml onll
4,
to 19 {dt
to 29 fet
30 to,!9 fet
50 to 70 fEt
5 to 6 storiE
7 b 12 storieG
Hud-laid hore/hydnnl E@dpip€Undeamined
E] PortableErtiaguisber E] P--mnnuhwAlrdnnlstandpip€
l5
I
19
I
20"
1
6
Fbme
rEl2D3E1D
:E?E
E EQUIPMENT
D.IvOL\IED
INIGNMON
13
IGNITION
OP
Gndebvelm9fet
'6 veLUE
t.oss
OFSTORIES
18 BUII,DING Yan)
TYPE
E st*ta
OFDAMAGECONFINED TO:
The objcr. of origin
Paa of mo or au of origin
Roo of origir
Fir-mtcd omp. olorigia
Floor of qigia
Strucun oforidn
Ertended bcvond rtructrre of onsi;
10
m
Ovs 70 f€t
13 ro 2{ sto.i6
25 to {9
5O emrie or oore
Undctrmined
Not Ctrarified Above
3 tp 4 mries
He4 Timber
Protact. St&l Prctet- Mebry EtL & Wood lnt.
UnprctatMmnryEn,&
Prctccted Wood Fme
Smolre
1E2E3E
4f,]5E6E,E
9E9 No &uge of the t)?e (N/A)
o
22 Follm Ilvct[rrioa Reguctcd
Pin Servie
2{ Mcober
Y- N
Dept. Responding
ARRIVALTIME
t"t 4a
TIMEBACX IN
SER\'ICE30 ao
ALARM T'II\{E
t1 3')lqq >
YEdR E sun
( uun
Tuc
Wed Fri
Thur El s"r*DAY OF
nEEtiMO
/^V/
DAY
1-\.r*
ISO CLASS3q'tfxZIP CENSUS TRACT
t 8Cz
7'{L - t 31/
TELEPHONEDOB loptionc.l)
TELEPHONEDOB (optionEl)ADDRESS
DOB (optional)TELEPHONEADDRESS
Sa-*e-
TELEPHONEDOB (optional)ADDRESS
E Roiu"a E ci'"o EI x,',c,
Mutual ol
4I OTHEB VEHICLES RESPONDED
ido Dot ilclude PA's)
I OF AERIAL APPARAT!'S RESPONDEDi OF ENGL\IES RESPONDED
2)
E RcmovedHazrd
E stnaay
E sa""g.
E not Ctasueo
TAKE},i
fi hvetigation
MOBII,E PROPERT\' (Complee line M)PROPERTI' COMPIJIi (U applieble)
SERT^L
'
LICEr-SE *MODEL1EAR
SERIAL *VOLTAGEMAKE
ITEM IIRST IGNITED:flRST IGNTIED WAS MADE OP
.00 .00CoDteDts
.00
Vehicle ud Contents
.00Buildiag.m
.00 .00oo.00 .00 .00
50,000-99999 sq ,r 5O0,000 rq ft10,00G19999 sq ft
fr RftE o-ggg ft
1000-{999 sq ftBUILDING SIz.F (Gmd Flr Only)
I
3
0
6
D
tru
D
DF
EguipEEtopcEt d
Eguip. sbould have oper.-did not
&uip. prwnt frrc te soall to oper.
Not classifpd above
Undetmined or oot reponed
Noeguipootpleat (N/A)
SprinLleaContrclledAre: YES D NO E
I of Hsdr Opeued
trEtr
tr
D
tr
tr
D
tr
I ID mD of origiD-oper.
2 NotiDmEoforigiD<pa.
3 ln m of origir -Dot oper-fu te EqEll
{ Not i! @ of origiD-not oper. fr tm euall
5 Ir mo of origin-nor oper. po*er dimuect
6 Not i! r of origir-not oper. poecr dimn.
7 In mm of origia-not opc!. dad bettrry
8 Notin mm of origir-Dotops. dadbGtttry
9 No d"t dor plwnt D ro Urdtt"*i."d
DETECTOR
Nubcr
otherFire
Deh b-)>4 )€tl.-
Title A;o,-
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EQLIPMENT II.JVOLVED I}i IGNTfION (CoEpie LiDe E)
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