HomeMy WebLinkAboutPermit Building 1999-01-07RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WOBK:
ASSESSORS MAP:
LOT
SPRINGFIELO
zL1
JOB NUMBER
225 Fifth Street
Sprlngfleld, Oregon 97477
?7oo r3
ST -SPR:
BLOCK:
TAX LOT:0/0oa
SUBOIVISION: '
72 O- /|ttoE:
BASTATE:
5qn fr-wr*
ZIP:4t+tte-e1twc 5
OWNER:
ADDR
CITY:
NEW
-
REMoDEL ADDrroN DEMoLTsH -X orHER
onFou"nDESCRIBE WORK:
ADDRESS PHONEbd"{3*
MECHAN 1
EXPIFIES a
EXP
ELECTFIICAL:
r FD IH s PE
the Oregon Utility
CONTRACTOR'S NAME
GENERAL:
lrtotilication Center.
obtain coPies of the rules bY
CONST.
CONTRACTOR #
PLUMBING:
onOretheroF!F Ec e&i0USE g
008SCente
RANGE:SQUARF. FOOTAGEWATER HEATER:
ZONING CODE:
HEAT SOURCE:SECONDARY HEAT:
CONSTR. TYPE:r OF BDBMS:
QUAD AREA:
r OF BLDGS:
-332-2344).
FLOOD I)LAIN
OCCY GROUP:
E OF STORIES:
# OF UNITS: _--
Fou
To request an inspection, you must caii 726-3769. This is a 24 hour recording. All inspections requested before 7:oO a.m, wlll bemade the same worklng day, lnspections requested after 7:OO a.m. wlll be macje the followlng work day.
REOUIRED INSPECTIONS
Temporary Electrlc Rough Mechanlcal - Prior to
cover.
Final Plunrbing - When allplumblng worl< ls complete.
Slte lnspectlon - To lre made
after excavatlon, but prior to
settlng forms.
Rough Electrical - Prior to Final Electrical - When all
electrical work ls complete.cover,
Underslab Plumblng I Electrlcal /Electrlcal Service - Must be
approved to obtaln permanent
electrlcal power.
Final Mechanical - When all
mechanical work ls complete.al - Prlor to cover.
- After trenches are Flnal Buildlng - When ail
required lnspectlons have been
approved and building is
completed.
excavated.Flreplace - Prlor to faclng
materlals and framing lnsp.Masonry - Steel locatlon, bond
groutlng.Framlng - Prior to cover.hil^ l/*,/rn,,
- After forms are
but prlor to concrete Wall/Celling lnsulatlon - prlor t
cover.
Underground Plumblng - Prlor
to Illllng trench.l--l orywalt - prtor to taptng
Underltoor Plumblng/ Mechanlcal
- Prlor to lnsulatlon or decklng.
MOBILE HOME INSPE TIONS
Wood Slove - After lnstallation.
Post and Beam - Prlor to floor
lnsulatlon or decklng.l-l lnsert - After flreplace approval
-
and installatlon of unlt.
l-_l glocking and Ser.Up - When ail
-
blocklng ls complete.
Floor lnsulatlon - Prior to
decking.Curbcut & AJrproach - After
forms are erected but prior toplacement of concrete.Sanltary Sewer - Prlor to titling
trench.
Slorm Sewer - Prior to fllling
trench.
Sidewalk & Drivervay - After
excavation ls complete, forms
and sub-base malerial in place.
Electrical Connection - Whenblocking, set-up, and plumbing
lnspections have been approved
and the home is connected tothe servlce panel.
Water Llne - Prlor to lllllng
trench,
Fence - When cciilpleted
Street Trees - When all requlred
trees are planted.
Final - After all required
inspections are approved andpgrches, sklrting, decks, andventlng have been lnstalled.
Rough Plumbing - Prlor to
cover.
tr,t tr .,'., i ilf,Hl,,ji
LAND USE:
E E
fl
fl
n Ptumbing Connections - When
-
home has been connected towater and sewer.
E
ACCP.L.HSE GAB
N
S
E
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Typt v
-
lnterlor
-
Corner
.- Panhandle \'
-
Cul-de-sac
1.- lS THE PROPOSED WORK tN THE.
HISTORICAL DISTRI T, OR ON
THE HISTOFIICAL REGISTER?
-
lf yes, thls appllcatlon must be slgned
arrd approved by the Hlstorlcal
Coordinator prlor to permit issuance.
APPROVED:
VALUE
q97 3z
80.fr)
{,0} /2.'tu
c6.? 5(A)
x $/so. FT.
Total Value
Building Permit Fee
State Srrrcharge
Total Fee
BUILDING PERMIT
ITEM SO. FT.
Main
Garage
Carport
BUILDING TAII'IE, FUTU CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordlnance
adopted by the City of Springfield, includlng the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
Plans Reviewed By
By:
t,12"
Receipt Numbe
Date Paid:
Flecei
upon violation of any
Plan Check Fee:
provjglons of sald ordlnances.
s2,97
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge ls 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
PLUMBING PERMIT
N.
FEE
FT.
FT.
FT
(c)
Plumblng Permlt
State Surcharge
Total Charge
ADDITIONAL COMMENTS
- Note:
Bl,jl9ing Inspector may requir.e
additional plans .information,
- and/or fees for the completion of
- this project.
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 Ordinanccs of the City of Sprlngfield, and the Laws
of the State of Oregon perlalnlng to the work descrlbed
herein, and that NO OCCUPANCY wlll be made of any
structure wlthout permission of the Bulldlng Safety Divislon.
I further certi{y that only contractors and employees who
are in compliance with ORS 701.055 wlll be used on thls
proiect.
I further agree to ensure that all requlred inspections are
requested at the proper time, that each address ls readable
from tlre street, that the permll card ls located at the front
of the property, and the approved set of plans will remain
Slg natu re
Date
q
times rlng con ructlonon the site
Wood Stove/ lnsert / Fl replace Unit
Dryer Vent
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sldewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
(D)
NoVent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Furnace
Exhaust Hood
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, Q and E Comblned)
|L1 L7 .7-7
_b32And
AMOUNT RECEIVED
RECEIVED BY
DATE PAIi')
VAI-IDATION:
RECEIPT NUMBER
t
W
??MB
DATE ISSUED:
lffi
StDE PERMIT NUMBER: '7,,//,,r),y' 1INSPECTTON LINE SEE TNSPECTIONS ON
APPLtgATtoN DATE:
FlFTH €)rtr,r'r-r/.€5
ENCRO.ACHMENT PERMIT
NUMBER:
SPRINGFIELO, OREGON 9?4??
ENGINEERING OIVISION
oFFlcE TELEPHONE (6031 726.3753
.LOCATION OF WORK
/43D FtPrn
oD_STATE:
sl
k-p2
atd
,.'^ ,14-, k,. isrp.r r.rrr^,
PHONE:'3
74/'c ,22
€ltn
-oo
7z:Ea,TaeraLADDRESS:
.1
ztP: 97H77
llpt 'bfaz.
EXPIRATION.DATE: ' /-7
*7 "7
PHONE:
APPLICANT
SITE ADDRESS:
CITY:
CONTRACTOR:
ADDRESS:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERVISOB:
,7.L
ZlPz
TAX MAP:
TAX LOTr
STATE: _rt E t
SUBDIVISION:
OWNER:
PHONE:
ACCOJT{I NOr
REOUESTED PERMITS:hBttcTtoNt ilot tilDs A?ttlcATtoN FE!
'oEFo8nQ erucnoAcHMENT pERMtr Nor El t"eo. od
Er
tr
tr
tr
Er
Q C10.00+t.l6/FT.
El clo.oo+ t.15/FT.
vAtD toi !tm, tro, DAYI rtoM DAtt ot Itu$lcrocursrREEr OBonE eorxen
Q ousr coN?RoL (TVrE opcorrtrnou
Q coHsmucloN, sroRAGE, srAotNo
Q orxen
I
I
0
tr
Q rsnralr
TYPE OF SECIIRTTY NEPOSIT
Q auxxer suREry BoND e sunttw aoHo O cAsH / cHEcK
E cung cuT pEBMrr No!.................... FT. rtLtstFrrrox: Q{Jfif , A?PROAC}tlfnA FORM8 An! IRECTIO-1qI ffi
e secouti bn,r*^r'f; lliT^?:ffITl-,'i -su^N'i" "- --"'
@ stoswaLK pERMrr No!.................... Fr.ffi
El.new O nEMovE / REpAtB E pAvE ptANT srntp
. _O'semecx e cunasroe El LENoTH
l{-sqcltosilorwArr, onvEw^y ron Au. clrlcim rAvtNOMADE
^FIEn ^u rxc^vllNo n cor,r-riiii.-iib-iiilfiffifi WIIHIN THE ETAEET AIOHT OF
ANO 8U}8A38 MATERIAL 18 N
FROM DATE:
TO
DEPTH:
WAY, TO 8EralcE.
E $6.ob /
El t5.oo /
TOTAL DUE;*I: TOTAL DUE WITH PERMIT I
o
tr SANITARY SEVVER CONNECTION PERMTT:
VALD FOA txw trot oAYt;roM DAT! O'r3EUAt{Cttrro sruB fl uarH UNE (EASEMENT-R/W E oTHERI sro RM SEWER CONNECTION PERMIT:V^tD toi Stxw t30l o^vt tioM o^tt or EEU Tlc!o clrcH BAstN , rusBLEn El srus e uarHune
pBQOF OF TNSURaNCF. CSOO,OOO MtNtMUrvt. Q rrrecxeo O REoutREo AMouuT
DESCRIPTION OF PROJECT:
PERIOD OF USE OB TIME OF CONSTRUCTION:
U PLANS (TWO SETSIATTACHED TlME:
TIME:AREA: LENGTH:I/VIDTH:
TYPEOFWORK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEIUTNT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE
NAME OF OTHER UTILITIES IF THIS IS A JOTNT
WARN]NG OEVICES TO BE UTILIZED:
HEIGHTI
BORE:
BACKFILL MATERIAL:
WORK SHALL COMPLY WITTI
worl ronc protcalm toE compllrnc. wlrh th.on Unllorm Tnlflo Dcvlccr
X ABTICLE 6 OF THE CTTY
Advtnca rnd
DESCRIPTION:
t
RtvtsloNs En1n6 roRM ' tt!COT,TTRAfiOR TO COMPLY WT}I MUTCD.
(MUTC0t.
AEIEITTflT{LdilI
E-
E__
--r
-t
BEVIEW COMMENTS , SPECIAL INS'I.}IUCTIONU8
gFf, [,gf'B'#JUBfd^?thtB,'518#f [--.ffi ['u'r[dff ,
E(ISTINO CITY CODES AND -, STUPUEUCE WTTH CUBRENT
00r
002
003
OO/f
00!
000 .
007
008
009
010
011
012
013
014
010
0t0
ot7
018
&ckllll wlth I'mlnur loclc
Comprct rvrry 18'loor drpth.
Rrguh.t oomprotton wlth r rrrl rollht.
A.C. to mltch th. gmtrr ol .xlrthe drpth or 4'.
All cuo rcrlcd lor llnd lnrprotlon.
Trmportry prtch mly br urod rt tho ottd ot tht dty.
Slgnlng rnd Zoo.'gtorctlon to comply wlth MUTCD
Cut oonctcr onlY on lcotc llncr or oold lolnr.
Sldrmlkr rnd drlvrwlyr mln 3,000pr!
Curblng mln 3,600pr1 I No pltohwo* lrlr thrn 3'.
Mmt mh. rcquhmtntt on curt outt, SPld. cod..
Rutor plantrd.rrcrt, Spld. codr 208.3.06
Sp.a. to Sort I Jrol I No A.C. qlr.
Mrchrnlcrl comp.cthg rcgulrcd.
No prtchwort.llow.d.
[.t.r.l our to hrvr oonttol d.ilw ,lll.
Cutt to b! polYmcrlzrd ctack ralcd lor llnal lnrpcctlon'
Mlnlnum 2'crurhrd rock I'mlnur.
019
020
021
o22
o23
024
026
026
o27
028
029
030
031
032
033I
Mlnurnurn 4' cbrrlncr .t rnY potnt. rwing'rwry.
Concr.t mlnlmum 4' dcpth. 3,OOOPrl.
Tranch to ba 'f' out. t
Nrcdr Stcr / CountV Prrmlt,
No rbovr ground rnolorlngr ln lldcwalk or hrndlcrp trmpl'
Dlrmond cut A.C./Concr.t. vlluc boxlr lo grrdc.
Fruh Oll rlgnr I Otrdcd.
Comply wlth Amrrlcanr wlth Olslblllti.t Act.
Concnb drbr, 72h[. curlng tlrnr, 450opcl,
Concr.t. rlrbt lcqulrc tolnt rlal mlttful.
Drlvrwry rrquku dowrlr rvrry 18'.
Submlt tnlllo cgntrol plln ptlo. to cxclvltion.
Notlly Tntllo Dlvlrlon bclorc cxcrvatlgn.
Corc drlll mrln llnr, ln.lrt tcc, 2% mln. gtadc.
Murt comply wlth tht provlrlonr ol ORS 757.541 to 757'671'
6' Ckcul., holo/H2O.Vrc.
Comments: '
L
THE
YOU ARE REOUIRED TO CALL
LANE UTILIIES c0 0RDINA:r-|NG- -cQu N glL's
7'6NE eAt-u NUrueER' 1 -800-332-2344
48 HOURS BEFORE DIGGING
t-l serufaRy sEWER, SToRM SEWEB, ENcRoACHMENT PEBMIT ANo OTHER INSPECT|ONS CALL CITY MAINTENANCE AT
- 728-3761,
E
SIGNATURE:
Lfttr""e;if*?'JB','J?g1's"11lii9"1r5?fJ*'ffr'"tl:ffi 3i"ii$Hti'a'd"i,l,tl3"'^!1?3[,!rme'
that proiect oddreas rs readabre from the 8t'eet'
//, ao
! haveand
-)
a-l -3t-77
not
on
r of the
work
n this
and
and
thle ,8t
AMOUNT RECEIVED:
RECEIVED BY:
,
RECEIPT NO:
I
DATE PAID:
I
Slgnature
ZoV,
Cotra'Teucrtau Dat6
VALIDATION:
E rnernc REvtEwED BY:
I uerrureNANcE:
E penrr,ttr tssuED BYi
FoR stDEwA* auo cuRB cw pEBMlrs ptAcE A coPY (aaMPLETEDI tN PERMIT DMWER.
DATE:
ir nuE oF coMPLErloN:
DATE:
OEPOSIT BETURNED:
ELB/ENTH
DATE:
DATE:
DATE:
DATE:
E enctrueERtNc REVTEWED BY:
DArp:
DATE:
DATE:
INSPECTION:
INSPECTION:
CALLED IN
CITY
NAME
CONCRETE.
ARE TO
BUT PBIOB TOARE MADE
th8
to
of
I