HomeMy WebLinkAboutPermit Mechanical 1995-12-18ua6
RESIDENTIAL
PERMIT APPLICATION
lnspectlons: 726-3769
Ollice:728-3759
SPRThlGFIELt)
Qfr,
JOB NUMBER
225 Fifth Street
Sprlngfleld, Oregon 97 477
LOCATION OF PROPOSED WORK 3p-r / /t /rtr,l il,*n
ASSESSORS MAP;TAX LOT:
SUBDIVISION:
-
LOT:BLOCK:
PHONE:
ztPSTATE:
OWNER:
ADDRESS:
CITY:
il r,t 14CMOLH
-.
OTHER
OESCRIBE WORK:
NEW ../ REMODEL ADD;TION D
ADDBESS EXPIRES PHONE
CONTRACTOR'S NAME
ELECTBICAL
MECHANICAL;
PLUMBING:
GENERAL:
CONST.
CONTRACTOB #
_ OFFICE USE _
r OF BDFIMS:
WATER HEATER;
BANGE:
LAND USE:
'/ OF UNITS
OUAD AFIEA:
r OF BLDGS:FLOOD PLAIN:
ZONING CODE:
SECONDABY HEAT;
SQUAFE FOOTAGE:
OCCY GROUpT
E OF STORIES:
CONSTFI, TYPE:
HEAT SOURCE;
To request an lns pectlon, you must callmade the same worklng day, lnspectio
726.3769. Thts ls a 24 hour recordlng. All lnsns requested after 7:00 a.m. wlll be made lh
pec tion.s requested before 7:OO a.mlowing work day,e fol . will be
I-l Temporary Electric
REOUIRED I NSPECTIONS
ftreh Mechanlcat - prlor to
Slte I nspectlon -Tobem ade
ft*rr: Ere,rtcar - Prror to
af ter excavat lon , but prlor tosettlng fo rms,
Underslab P'lumblng
- Prlor
I Eleclrical IMechanlcalto cover.Etectrlcal (;'m*HrL?,;"yl;i"iJlServlce- Must be
Footlng - A
approved
electrlcal to obtal n permanent
excavated fter trenches are power.
li:XX,% ;,ilunu "
o
"u,, o n, b o n d
i:i:*{fil ; *'t:' r:rT: ff "
;:i5,',i, : ;#* i : r'T,g:
Framlng - prlor to cover..
Fjii#{'diltr,,?#il 3,?'o u u n
Watl/Celllng lnsulatlon _ prlor to
Drywall _ prlor to taplng.
Wood Slovo - After ,nstallailon.
ffio,n",t
r'd'ff ;',fl ;'Hd?ru mbrns - Pri or
3 ff ,1',"1J,?,1ff1,,,:?, llT*[,,;;]
.f .l- -n
-F//aZ 46.
MOBILE HOME INSPE TIONS
,?""",1 j,?S"i",,"x! ;, I,il., t o rr o o r
5::?i"';,"'"rron - Prror to
*"." ;|;,fl l,L,,j? ?;[: a p p ro vs,
P^:f^"lt& Approach _ Afrer
;?:T";1:,";ec teo o" t p'i oi"if
8ffI,ff,i'i"i"J;y[ - when a,,
[il#!;;ii"J"*:*Tr"^Sanltary Sewer _ p,r
trench., vv,,s, _ rrlor to fllling
f,ffi.""r"r - Prlor ro lmns
,y;;:r,.'.r,r" _ prlor ro fiillns
;il:;fi'irim*[r,,ej[i
Fence - When cornpleted,3y"|ffi:{"}['J#;.Ii.
f i;;1?, Prumbrns - Prror to tl ;y;;:[Tffiy^en arr requrred *ifi';[t&*ii:r,.#
/ 9or:
?7+rz
tl fil*#il,.j:,:,
" "y,ffilill
{.r,':;l;,"i",jJl?i,, J" y,ff i: fl l
r
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Type, .
--
lnterior
-
Corner
-
Panhandle
-
Cul-de.sac
1 - IS THE PFIOPOSED WORK IN THE .
HISToRICAL DtsTRtCT, OR ON
THE HISTORICAL REGISTEFI?
-
lf yes, thls appllcailon must be slgnedand approved by the Hlstorlcal
Coordlnator prlor to permlt lssuance.
APPROVED:
P.L.HSE GAR ACC
N
S
E
qlltlDtNc VALUE, PLAN CHECKAND BUILDING PERMTT
Thls pelmit ls granted on tho express condiilon that the sald
construclion shall, ln all respects, conform to the Ordlnanceadopted by the City of Sprl ngfleld, inctudtng the
Development Code, regulating the construcilon and use of
bulldlngs, and may be suspended or revoked at any time
upon violatlon of any provislons of sald ordlnances.
Plans Reviewed By Date
Flecelpt Numbe
Date Pald
Received By:
Plan Check Fee
BUILDING PERMIT
VALUE
(A)
SQ. FT, X $/SQ. FT.ITEM
Main
Garage
Carport
Total .Value
Building Permit Fee
State Surcharge
Total Fee
Systems Development Charge ls due on all undeveloped
properties wlthin tlre City limlts whlch are belng lmproved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
ITEM
Flxtures
Besldentlal Bath(s)
SanltarY Sewer
Water
Storm Sewer
Moblle Home
FEE
(c)
No
FT.
PLUMBING PERMIT
Plumblng Permlt
State Surcharge
Total Charge
Wood Stove/ lnsert/ Flreplace Unit
Fu rnace
ANICAL PERMIT
a/
,7 f 'f ,y'f
(D)
/'/ c"
2-O
N0
Dryer Vent
Exhaust Hood
Vent Fan
@
errr /zss l,
td@
Mechanlcal Permlt
lssuance
State Surcharge
Total Permlt
/,2o
By slgnature, I state and agree, that I have caref ully examlned
the completed applicatlon and do hereby certlfy that all
lnformatlon hereon ls true and correct, and l f urther certl(y
that any and all work performed shall be done ln accordance
wlththeOrdinancesoftheGltyofsprlngfleld'andtheLaws
of the State of Oregon pertalnlng to the work descrlbed
hereln, and that NO OCCUPANCY wlll be made of any
structure wlthout perrnission of the Bulldlrrg safety Dlvlslon'
lfurthercertifythatonlycontractorsandemployeeswho
are ln compliance wlth ORS 701'055 wlll be used on thls
prolect.
to ensuro that all requlred lnspectlons are
roper tlme, that oach address ls readable
at the permlt card ls located at the front
d the approved set o( plans wlll remaln
Slgnature
Date
I f urther agree
requested at the P
from the street' th
of the ProPerty' an
imes durlng constructlon'on the slte at all t
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sldewalk "- {t
Curbcut ..- ft
Demolitlon
State Surcharge
(E)Total Miscellaneous Permlts
VALIDATION:
RECEIPT NUMBER
DATE PAID
TOTAL AMOUNT DUE (excludlng electrical)
AMOUNT RECEIVED
(A , B, C, D, and'E'Comblned)
n,/ 24
- -41r BECEIVED BY
o
S7 t r ri* 4- i- ,/4 z;/-
FT.
/.*
I
s', $c'FtELo
,88,
t
::*:J::Hl'-Blil
app{o'/e\'?BB$fl AP?LICATION
EIN. TPJCAL 5Nunber
rEE SCffiDUIS BELOqT#;t$i$'q$;r
OFBICE: I zo-st
e7 411
126-1769
3. COHPIETE
t rans ferabl e and exPir
*Li:;:*;i;' ;:;'il:ti'[ uni'l
;.;;i." rncludedt ,."*s cost
i".r, .lartionar 5oo":;: ;i or Portion 's 1s.oo
,lli'iil,r'd-Home or -"iloaufut Dvelling s 40.00
Service or Feeder
re non-
snots iarted vith 1 n 180 daYs
A"A
1 Sum
I6 5b
Permits a
if vork i
of lssuan
180 daYs '
e
,r
nCv
50
ceori f vork is su spended fo
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor e*o icio lt \
Address {Qn s.k
Ci tY A Phone
Supervisor Licen se Number 3 tl 5
Expiration Date
Constr Contr' Numb D*3)c
B. Services or FeedersD' il.tufr^tion' Alterations
^)(.
or Relocation:
200 amPs or less ' I S 50'00
201 amPs to 400 amPs S 60'00
401 amPs to qgg^u*Ps -- Sloo'oo
601 amPs to 1OOO 9*Pt- 5130'00
over looo l*Piz'ort;
-
S3oo'oo
b,TemporarY Services or Feeders -iitluri.iion, Alteration or RelocatlonC
r
Expiration Date (,
S ture of 1 Electrician
0vners Name Jo nx1
Address Ahot e ( 3 tYriY-uto u-)
200 amps''or less
201 amps to 400 amPs
-
0ver 401 to 600 amPs
0ver 600 amPs or 1000 -voITs see t'a6ove
D- Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit
Each Addi tional
Circuit or vith Service
or Feeder Permit
$ 3s.00
s 2.00
E- Miscellaneous (Service,/feeder not included)
-Each installation
Pump or irrj.gation
Si gnlOutline Lighting-
Limi ted Energy/Res
Limited Energy/Comm
s
$
s
00
00
00
BU
40
55.
80.
Ci ty Phone q,
OVNER INSTALLATION
The installation is belng made on
property I ovn vhich is not intended
for sa1e, lease or rent.
Ovners Signature:
DATE
00s40
$40
$20
$36
.00
.00
.00
BRECEIWD
5. SUBTOTAL OF ABOVE
57" State Surciarge
3Z"_Adnini.s tra ti rJ F""TOTAL
fr)
)
JOB
7a1 r3 6t
1-n,n