HomeMy WebLinkAboutPermit Building 1997-01-03RESIDENTIAL
PERMIT APPLICATION
lnspections: 726.3769
Office: 726.3759
SPrlINGFIELE}
JOB NUMBER
225 Fifth Street
Sprlngfleld, Oregon 97 477
o
Z
2fr,
LOCATION OF PBOPOSED WORK:
ASSESSORS MAP;TAX LOI
LOI
-
BLOCK:SUBDIVISION
PHONE:
ZIP:
7
STATE:CITY:
ADDRESS:
OWNER:
NEW
-
BEMODEL ADDITION DEMOLISH OTHEFI
DESCRIBE WORK:
ADDRESS
o
?
EXPIRES PHONECONTRACTOR'S NAME
MECHANICAL:
ELECTBICAL:
CONST.
CONTRACTOR #
GENERAL:
PLUMBING
FIANGE:
, OF BDNMS:
- OFFICE USE -
WATER HEATER:
r OF UNITS:
QUAD AREA:
r OF BLDGS:
FLOOD I]LAIN:
ZONING CODE
SECONDARY HEAT:
SQUARF- FOOTAGE:
LAND USE:
OCCY GROUP:
* OF STORIES:
CONSTR. TYPE:
HEAT SOURCE;
To request an lnspectlon, you must call 726-3769. Thls ls a24hour recording. All inspections requested before 7:00 a.m. wlll bemade the same worklng day, lnspections requested after 7:OO a.m. wlll be made the following work day.
REQUIRED INSPECTIONS
[--l Temporary Electrlc
Slte lnspectlon - To be made
after excavatlon, but prior to
settlng forms.
Underslab Plumblng/ Electrical /
Mechanlcal - Prlor to cover.
Footlng - After trenches are
excavated.
Masonry - Steel locatlon, bond
beams, groutlng.
Foundallon - After forms are
erected but prlor to concrete
placement.
Underground Plumblng - Prlor
to fllllng trench.
Underlloor Plumblng/ Mechanlcal
- Prlor to lnsulatlon or decklng.
Post and Beam - Prlor to floor
lnsulatlon or decking.
Floor lnsulallon - Prior to
decklng.
Sanltary Sewer - Prior to fllllng
trench,
'E{ nough Mechanlcal - prtor to
)Acover.
JYnough Electrlcat - Prtor to,/z4,over.
Final Plumbing - When ailplumblng worl< is complete.
E
E Storm Sewer - Prior to fllling
trench.
Waler Llne - Prlor to filling
trench.
Rough Plumbing - Prior to
cover.
[--l Sidewalk & Driveway - Afteru excavatlon ls complete, forms
and sub-base material in place.
Flnal Bulldlng - When all
required lnspections have been
approved and building is
completed.
Other
MOBILE HOME INSPE TIONS
Blocking and Set.Up - When all
blocklng is complete.
Plumbing Conneclions - When
home has been connected to
water and sewer.
Electrical Connection - When
blocking, set-up, and plumblng
lnspections have been approved
and the home is connected to
the servlce panel.
Final - After all required
lnspections are approved and
porchcs, skirtlng, decks, and
ventlng have been installed.
ffi Framlng - Prlor to cover..r+
[![wattlCelllng lnsulatlon - Prtor toFl cover.
fto*'tl - Prlor to taolng'
[-_l WooO Stovo - After Installatlon.
Electrical Servlce - Must be
approved to obtaln permanent
electrlcal power.
Flreptace - Prlor to faclng
materlals and framing lnsp.
lnserl - After flreplace approval
and lnstallatlon of unlt.
Curbcut & Alrproaclr - After
forms are erected but prior lo
placement of concrete.
Fence - When completed.
Slreet Trees - When all requlred
trees are planted.
'ly''l flnal Electrlcat - When ail
Hetectrical work is complete.
|llFlnat Mechanicat - When ail
f iltcchanical work ls complete.
E
E
E E
tl
tl
tl
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
P.L.HSE GAR ACC
N
S
E
IS THE PROPOSED WORK iN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this applicatlon must be slgned
and approved by the Historlcal
Coordinator prior to permit issuance.
APPROVED:
VALUE
J?pcT tGqq4=__
"z5e
/o,'7o'f 6f / 7,Lt
2327L
35rua
(A)
BUILDING PERMIT
Total Value
Building Permit Fee
State Surcharge
Total Fee
SO. FT. X $/SQ. FT.ITEM
Main
Garage
Carport
BUTLDING 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.
Plans Fleviewed By Date
Receipt Numbe
Date Paid
Received By:
Plan Check Fee:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
FEE
(c)
No
FT.
FT.
PLUMBING PERMIT
Plumblng Permlt
State Surcharge
Total Charge
ADDITIONAL COMMENTS
2
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
Mechanical Permit
lssuance
State Surcharge ,7 f t ,4{
Total Permit (D)
15i-
n ?!-o
Vent Fan
MECHANICAL PERMIT
Furnace
Exhaust Hood By slgnature, I state and agree, that I have carefully examlned
the completed application and do hereby certlfy that all
lnformatlon hereon is true and correct, and I f urther certlfy
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 wlthout permission of the Buildlng Safety Division.
I further certify that only contractors and employees who
are in compllance with ORS 701.05S will be used on thls
proiect.
I further agree to ensure that all required inspections are
requested at the proper tlme, that each address ls readable
from the street, that the permit card ls located at the front
of the property, and the approved set of plans wlll remaln
on the site at all times during con
Slgna
Date
lon
slrz//7
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Penni ls (E)
TOTAL AMOUNT DUE (excluding clectrical)
(A, B, C, D, and E Comblned)
25825 ,r
2
DATE PAID
AMOUNT FIECEIVED
RECEIVED BY
VALIDATION:
RECEIPT NUMBER
" FT.
/5 Ret ,)
..2,//{).
N0
Jar-
/,2,
\
SP}....C:FIELD
The following proieci
zontng, ancj doegnotapproval.
as submittad has the folrequirespecific land us€@ft,
rL
225 FIYIE STRXET
SPRINGFTELD, OREGON 974
Date
INSPECTf0N REQUEST: 726-3769
OFFICE: 726-3759
1 OF r0N
ELECTRICAL PERHIT PLICATION
Signature
Job Nunber
3. COHPLETE FEE SCEEDIILE BELOV
Nev Residential-Sj.ng1e orMuIti-Family per dvelling unit.
Service Included:
f tems Cos t
A
'1ffiT4)o
g*r1?t DESfrEPT?N
Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for
180 days.
Sum
2. CONTRACTOR
Electrical Contractor
Supervisor CENSE at?-43
Expiration Da,. \t) . \
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Owners Name L
Address L(4 I
cit i1
L Phone 10-707
OVNER ALLATION
The installation is being made onproperty I ovn vhich is not intendedfor sale, Iease or rent.
Ovners Signature:
DATE:/z- 7- 4a
1000 sq. f t. or l-ess
Each additional 500sq. ft or portion
thereof
Each Manuf'd Home. or
-
Hodular Dvelling
Sertice or Feeder
s 85.00
s 15.00
s 40.00
B Services or Feedersfnstallation, Alterationsor ReLocation:
200 amps or less
201 amps to 400 amps
-
401 amps to 600 amps
-601 amps to 1000 amps-
Over 1000 amps/vo1ts
-
Reconnec t OnIy -l-
s s0.00
s 60.00
s100. 00
s130.00
s300.00s 40.00
C Temporary Services or FeedersInstalIation, Alteration or Relocation
200 amps''or less $ 40.00
20L amps to 400 amps
-
$ 55.00
Over 401 to 600 amps
-
$ 80.00
Over 600 amps or 1000-voITs see rrBrr aEov€
D. Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuj.t S 35.00
Each Addi tional
Circuit or vith Serviceor Feeder Permit S 2.00
E. Miscellaneous (Service/feeder not included)
-Each i.ns tallation
Pump or irrigation
Sign/Outline Lighting-
Limited Energy/Res
-
Limi ted Energy/Comm
SUBTOTAL OF ABOVE
5Z State Surcharge
32 Administrative Fee
TOTAI,
TTON ONLY
.""Q,s ,qfr'.[Addr
Ci ty ne \o L
wr)
tl
s 40.00
s 40.00
$ 20.00
s 36.00
RECETVED to>
5
q3
QrQrlt
1
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Oftice: 726.3759
:;PFlINGFIELD
qil,
JoB NUMBE " %48---
225 Fi ttlr S r rcet
Springtlelcl, Oregon g7477
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:TAX LOT:
LOI ELOCK:SUBDIVISION:
--
%
OWNER:PHON E
ADDRESS:
CITY:STATE ZlPi
DESCRIBE WORK
NEW
-
REMoDEL ADDlrloN DEMOLISH orHEtl
-
CONTRACTOR'S NAME ADDRESS CONST.
CONTRACTOR ,EXPIII ES PHONE
G EN ERAL:
MECHANICAL:
ELECTRICAL
To request an lnspectlon, you must call 726'3769. Thls ls a 24 hour recorcllng. All ln$pections re(tuestecj belore 7:00 a.rn. wlll bemade the sante worklng day, lnspections requested after 7:00 a.m. wlll be made thc tollowlng work day.
REOUIRED INSPECTIONS
[-_l Temporary Electric Rouglr Mecltanical - prlor to
cover.
Flnal Pltrrnbing - When allplumbing worl( ls completc.
Site lnspoctlon - To be made
af ter excavation, but prior tosetting forms.
Rough Electrical - prior to
QUAD AREA:
, OF BLOGS
OCCY GROUP:
I OF STORIES:
WATER HEATEF
Underslab Plumbing/ Electrical /Mechanlcal - Prior to cover.
Footlng - Af ter trenches are
excavated.
Masonry - Steel locatlon, boncl
beams, groutlng.
Foundallon - After forms are
erected but prlor to concrete
placement.
Undcrgrouncl Pltrnrblrrg - Prlor
to fllllng trench.
Underlloor Plumbing/ Mechanical
- Prior to lnsulatlon or decl<ing.
Post and Beam - Prlor to floor
lnsulatlon or decklng.
Floor lnsulation - Prlor to
decklng.
Sanilary Sewer - Prior to fllling
lrench.
Storm Sewor - [)rior to fllling
trench.
Water Llne - Prlor to filling
trench.
CONSTR. TYPE:
--
- OFFICE USE _
LAND USE:
, OF UNITS
HEAT SOURCE
RANGE:
cover
Electrical Servlce - Must be
approved to obtairr perrnancnt
electrlcal power.
Flreplaco - Prlor to faclng
materlals and f raming lnsp.
Framlng - Prlor to cover.
Wall/Celling lnsulation - Prlor to
c over.
FLOOD I]LAIN
ZONING CODE:
r OF BDRMS:
SECONDABY HEAT
SOUAni: FOOTAGE
Final Electrical - When allelectrical worl( is complete.
Firral Meclrarrical - When allmechanical worl< ls cornplete,
Final Building - Whon allrequlred lnspectlons have beenapproved and building ls
com ple tcd.
O thor
MOBILE I.IOME INSPESTIONS
Blocking and Set.Up - When allblocklni; is complete.
Plumbing Connections - When
trome has been connected to
water and sewer,
Electrical Corrnection - When
blocking, set.up, and plumblng
l,rspcctions lravc bc'cn approvcd
and tlle ttorno is connecled tothe service panel.
Final - Af tcr all requlred
lnspcctlons are approved andporchcs, skirting, decks, and
ventlnO have been lnstalled.
m Curbcut & Alrprroach - After
forms are erected but prior toplacemcnt of concrctcr.
Sidewalk & Drlveway - Af ter
cxcavation ls completc, fornls
and sub.base malcrial i11 placo.
[--l fence - When compteted
{ilreol Troes - Wlren all requlred
trees are planted.
Rough Plumblng - Prior to
cover.
7_7-?z-''-
PLUMBING:
t_l
r_l
[--l orVwatl - Prlor ro raping.
J I WooO Stove - n frer lnsrailarton.
[-.l lnsert - Alter flreplacc approval'J and lnstallatlon of unlt.
tl
Lot faccs
Lot sq. ltg.
Lot coverage
TopograPhY
Total helght
BUILDING PERMIT
Lol 'ly;.rc
-
lntcrior
--
Corner
-
Panhandle
-
Cul-de-sac
acl<s
PL.HSE ACC
N
C
E
GA
VALUE
APPROVED
ITEM
Main
Garagc
Carport
SO. FT. X $/SO. t:T.
Total Valuc
Buil<.ling Permit Foc
Statc Surcharge
Total Fcc (A)
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This pernrit is grarrtecJ on the cxpress conclition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City ol Springfield, including the
Developrnent Coclc, regulating the construction and use of
buildings, and may be suspended or revoked at any tlme
upon violation of any provisions of said ordinances'
DatePlans Reviewed t3Y
Receipt Nutnt:c
Plan Ctreck Fec
Date Paid
Received By:
Systems Development Charge is due on all undeveloped
properties within tlro City linrits whiclr are being improved.SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
FEE
(\-)
N0
F'r.
FT.
FT.
Rcsldential Bath(s)
PLUMBING PERMIT
Plumblng Pormlt
Statc Surcharge
Total Charge
Sanitary Sewer
Water
Storrn Sower
Mobilo Hotne
ITEM
Fixtu res
By slgnature, I state and agree, that I have caretully examlned
tlre completed application and do hereby certlfy that all
lnformation hereorr is true alld correct, and I f urther certlfy
that any and all work performed shall be done in accordance
wlth the Ordinanccs of thc City o( Springfield, and the Laws
of the State of Orcgon pertainlng to thc work described
herein, and that NO OCCUPANCY will be made o( any
structure without perrnission oI the Buildirrg Safety Divislon.
I f urthcr certi[y that only contractors and employees who
are in cornpliance wltlr ORS 701.055 will be used on thls
proiec t.
I f urthcr agree to ensurc that all required lnspections are
requested at the proper l,ime, that each address ls roadable
(rom tl.re street, that the permit card ls located at the front
of the property, and the approved set of plans will remain
on the slte at all times during constructlon.
Signatu
Date ??-7-- -'----'
Wood Stove/ lnsert / Flrcplace Unil
Dryer Vent
MISCELLANEOUS PERMITS
Mobile Home
Stale lssuance
Statc Surcharge
Sidewalk
--
tt
curbcut 7 2- t,
Oemolition
Stale Surcharge
Total Mlscellaneous Perlnits (E)
H@
Nt0Vent Fan
(D)
M ECHAN ICAL PERMIT
Furnacc
Exhaust Hood
Mechanical Permlt
lssuance
State Surcharge
Total Permlt
TOTAL AMOUNT DUE (cxclucling clectrical)
(A, B, C, O, and E Cotnbitrcd)
VALIDATION
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVT..D
FIECEIVED BY
a
II- E TJI1OPOSED WORI( iN THE
I{IYTORICAL OISTBICT, OR ON
TIIE HISTORICAL REGISTER?
lf yes, this applicatlon must be slgned
and approved bY the Historlcal
Coordinator prior to permit issuance.