HomeMy WebLinkAboutPermit Building 1993-11-08SPNII\rGFIELD
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726'3769
Office: 726-3759
qs/s37
h,
JOB NUMBER
225 Fifth Street
Springf ield, Oregon 97 477
LOCATION OF PROPOSED WORK
ASSESSORS MAP:TAX LOT:bo
LOT:BLOCK:SUBDIVISION
PHONE:
OrtZf
ZIP:STATE ?><2<z
7-Hzza.\
CITY:
ADDRESS:
OWNER
NEW
-
REMODEL ADDITION DEMOLISH OTHEFI
DESCRIBE WORK:
EXPIRESADDRESS
5 -2
MECHANICAL:
PHONE
)e*ra) o4.
CONTRACTOR'S NAME
PLUMBING:
GENERAL:.
CONST.
CONTRACTOR #
RANGE
* OF BDRMS:
_ OFFICE USE -
ZONING CODE:
FLOOD PLAIN
WATER HEATER:
HEAT SOUBCE
* OF UNITS:
LAND USE:
SECONDARY HEAT
SQUARE FOOTAGE:
OUAD AREA:
* OF BLDGS:
OCCY GROUP:
* OF STORIES:
CCNSTR, TYPE:
--
To request an inspection, you must call 726-3769. This is a 24 hour recording. 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 Temporary Electricll
Rough Mechanical - Prior to
cover.
Final Plumbing - When all
plumbing work is complete.
Site lnspection - To be made
after cxcavation, but Prior to
setting forms.
T< nough Electrical - Prior to {-7 Final Electrical - When attAover. Helectrical work is complete.
Underslab Ptumbing/ 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.Fireplace - Prior to facing
materials and framing lnsP.
X Final Building - When all
required inspections have been
approved and building is
completed.Masonry - Steel location, bond
beams, grouting.lV4raming - Prior to cover.J\
ffiw"rttCeiling lnsulalion - Prior to
-
covef.
Other
Foundation - After forms are
erected but prior to concrete
placement.
Underground Plumbing - Prior
to filling trench.ff"*^ll - Prior to taoing
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 Sel-Up - When all
blocking is complete.
Floor lnsulation - Prior to
deckirrg.Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Plumbing Conneclions - When
home has been connected to
water and sewer.
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 - After
excavation is complete, forms
and sub-base material in place.
Water Line - Prlor to fllling
trench.
Rough Plumbing - Prior to Street Trees - When all required
trees are planted.
Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.covet
,/<,tu:")2-8<
AlfA ,^ '
tl
E
tl
E
tl
E
E
E
tl
tl
X
f-l fence - When cornpleted.
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MOBILE HOME INSPECTIONS
n
rtl
Lot faces
Lot sq. ftg.
Lot coverage
TopographY
Total height
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de'sac
P.L.HS ACC
Setbacks
GAR
ISYHE PROPOSED WORK IN THE
}lISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-_
lf yes, this application must be signed
and approved bY the 11 istorical
Coordinator prior to permit issuance.
APPFIOVED:
N
D
E
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This pcrmit 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
Developrnent 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.
Plan Clteck Fee: . ,---
Recei pt Nutnber:-
DatePlans Rcviewed BY
Date Paicl
Received BY
FnG aa.,aMe ,qF&- 2-+@
VALUE
(A)
X $/SQ. FT.
I ,o
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carport
/zoi'_
-ef:
Systems Developrnent Charge is due'on all undeveloped
properties within the City limits which are being improved.SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
ITEM
Fixtu res
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
1oo
&G
/ zdo.l-2-) t .-(c)
No
FT.
FT.
Fi.
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
Wood Stove/ lnsert/ Fireplace Unit
Dryer Vent
MECHANICAL PERMIT
/5ffi
zf]r(D)
N0
Od
fo
Mechanical Permit
lssuance
State Surcharge
Total Permit
Fu rnace
Exhaust Hood
Vent Fan
By signature, I state and agree, that I have caref ully examined
the completecl application and do hereby certify that all
information hereon is true and correct, and I f urther certify
that any alrd all work performed shall be done in accordance
with the Orclinances of the City of Springf ield, and the Laws
of the State of Oregon pertaining to the work described
herein, ancJ that NO OCCUPANCY will be made of any
structure without perrnission of the Building Safety Division'
I further certify tlrat only contractors and employees who
are in 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 re4dable
from the street, that the permit card is located at tfG-(ont
of the property, and the approved set of plans will remain
on the site at all times during construction' \
Sig natu re
Date
MTSCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut .-_- ft
Demolition
State Surcharge
Total Miscellaneous Permlts (E)
'/ - 7" -;'l
2_-./o 7 gDATE PAID
AMOUNT RECEIVED
RECEIVED BY ---
VALI DATION:
RECEIPT NUMBER
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
}G?J_g
_ __,? -r_
I
CITY OF
, JOB DESCRIPTION
G:L-2
Permi ts rable and expireif sork is not start'ed rr.r'tbin 180 daysof issuance or if vork is sgspeaded for
180 days.
2. COITIRACTOR INSTAII,ATION ONLI
Electrical Contractor 0REG0l,l ELE$RlC SERVICI
AddressiS)r, (, ) -),r?- Frn. ,
Ci ty Phone €/€ - /6 [i
Supervisor,cense Ntimber /jgJ t.\.
ExpiratiooDate /U - /- ?S-
Constr Contr. Number ,--]._rcl (:_
Expiration Date q 1
ture of Supervising Eleetrician
Ovners Name
Ci ty Phone
OIINER INSTALI.ATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Ovners Signature:
DATE:
RECETPI *:
,1
1000 sq.ft" or less
Each ,additional 500
sq. ft or portion
thereof
Eaeh }lanuf 'd ffome or
s 8s-00
s 1s.00
ilodular Dvelling
Service or Feeder s 40-00
Services or Feederslnstallation, Alterations or
Relocati on:
200 amps or less
201 aurps to 400 a,nps
-401 amps to 600 amps ]601 amps to 1000 anps_
0ver 1000 amps/volts
Reconnect Only
Tenporary Services or Feeders
Installation, Alteration or Relocation
Hiscellaneous (Service/feeder
-Each ins.tallation
Ptrmp or irrigation $
Sign/0utline Lighting_ SLinited Energy/Res S
Limited Energy/Comm S
225 ETETE STREET
SPRINGFIELD OREGON 9,
INSPECTION REOtIBSf,:
OFEICE: 726-3759
1. IOCArION OF
B
C
s s0.
$ 60.
$100.
00
40
$r.30
00
00
00
00
00
00
$g
$
I r- *- | -200 amps or less S 40.00
0ver 401 to 600 amps _ S 80.00
Over 600 amps or 1000 volts see *Bn above
D. Branch Circuits
Nev, Alteration or Extension Per Panel
one circuit t S ss.oo €S_5u
Eaeh Additional
Circuit or vith Service
or Feeder Perni r lL) $ 2.009-f
E
5 SIDTOTAL OF ABOVE
5f State Surcharge
TOTAL
not included)
40.00
40.00
20.00
\a@
,a <rS
RECETVED BY -b es
Items
aaaressltl{S Lr,u--r^ ( /1, / (
sPrrrNGFrr:LL)
225 FIFTE STRBEf,
SPRINGFIEIJ, OREGON 97477
INSPECTI0N RBQI EST. 726-
OFPICE: 726-3759
1
as
not rgqu ire opeoilic land uce
ELECT?.ICAL PERHIT APPLICATION
200 amps or less
0 n 201 amps to 400 amps
-L /.- 401 amps to 600 amps _601 amps to 1000 amps_
Over 1000 amps/volts _
Reconnect 0nly
fne
zoning, and
approval.
Authorued
m
3\
--" -\' \
Permits are\ non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for
180 days.
2. COIflRACTOR INSTALI.ATION ONLY
Electrical Contracto
City Job Number
SCEEDULE BBLOV
Nev Residential-Single or
HuIti-FamiIy per dvelling unit.
Service fncluded:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
$ 8s.00
s 1s.00
$ 40.00
Services or Feeders
Installation, Alterations or
Relocation:
&ee*N_'$ot2
A
Sum
r JOB DESCRIIPTIONt t rn lr Vrt"r-:t -\L-
B
Addr
Ci ty
Supe
$ s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
40.00
s5.00
80.00
e rBl|
ess
rvisor Li cense Number A7 2C-S
Expiration Date q
c. Temporary Services or'Feeders
Installatlon, Alteration or RelocationConstr Contr. Number
Expiration Date b+Au
Electrician
200 amps or less I S
201 amps to 400 amps
*
S
over 4b1 to 500 amps
-
$
0ver 600 amps or 1000 volts se a5oIil
Signature of Supe rv
Ovners Name
Address \c
Ci ty one
OVNER
The installation is being made on
property I own which is not intended
for sale, Iease or rent.
0rners Signature:
DATE:
D. Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $
Sign/Outline Lighting_ S
Limi ted Energy/Res $
Limited Energy/Comm $
ST,BTOTAL OP ABOVB
5Z State Surcharge
TOTAL
40.00
40.00
20.00
36.00
OFEGO'U
RECEIVED BY:
5 U)
@
FiRE DA},IA.GE REPORT
OR
ELECTRiCAL HAZARD
,)bffi 3t50-/
DATE:tD-s-? 3
TO:
FR0t'1:
SUBJECT:
Bu'i'ldi ng Department
Springfield Fire Department
Structural Damage to Building
Address or 'location of bu'ilding
Name of ov,ner
Type of buiiding
Estimated value of building
Estinrated loss to building
Date of fire
(Dwelling, S e, l{arehou , etc. )
$ 30,ooo
to -s-13
Location or damage i n bu i'l di ng
(""+, tDa( Is d"r k , efrcttat a rw) in*cntor.
TRcof,-ra1l , Exterior, interior, etc.)
Structural weakness as a resu'lt of the f ire
(Burned raf ters , Beams , .lo i s ts , etc . )
Addr'ti onal oert'i nent i nfcrna t,'on e
PO o
El ectri ca i iJazard
(,l./iring, 0utl ets , etc. )
q3
S'iq ned
;t"
/,.'
$ i ao, DDh