HomeMy WebLinkAboutPermit Building 1994-09-19RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:lb
ASSESSORS MAP:
LOT BLOCK:
SP'lINGFIELD
-rCL
JOB NUMBER I
225 Fifth Street
Springf ield,
TAX LOT:
SUBDIVISION:
-OWNER:
0/-4ltzzSTATE:ZIP:CITY:
J, LaGt--\-3 lqz
A\o-wS GUfl5u€-/
5P t-vo
PHONE:
.Eltb pe. t2'
;1JOA I Aco t.4 JktA
NEW
-
REMoDEL ADDtrtoN DEMoLtsH orHER C't ru'- W-P r\ t e- :
DESCRIBE WORK:
EXPIRES
ai
l.-l-t-Ct A-t C 1Lq, 5 t o8
CONST,
CONTRACTOR
Clta *l Vtaurg;1
PLUMBING:
MECHANICAL:
ELECTRICAL:
PHONE
7 6t't
CONTRACTOR'S NAME
GENERAL:V\ru5 ADDRESS .\ a
hrt 3-f a-t3t c .-) (o C
BANGE:
- OFFICE USE -
ZONING CODE:
FLOOD PLAIN:QUAD AREA:
* OF BLDGS:
SECONDABY HEAT:
SOUARE FOOTAGE:
, OF BDRMS: ,.
LAND USE:
WATER HEATER:
OCCY GROUP:
* OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
# OF UNITS:
-
To request an lnspectlon, you must call 726-3769. Thls ls a24hour recordlng. All lnspections requested before 7:00 a.m. will bemade the same worklng day, lnspectlons requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
Temporary Electrlc Rough Mechanlcal - Prlor to
cover.
Final Plumbing - When ailplumblng work is complete.
SIte lnspectlon - To be made
after excavatlon, but prior to
settlng forms.
flfl Rougfr Electrical - Prlor tolJ cover.
Underslab Plumblng/ Electrical /
Mechanlcal - Prior to cover.Electrlcal Servlce - Must be
approved to obtain permanent
electrlcal power.
Final Mechanical - When all
mechanical work ls complete.
Footlng - After trenches are
excavated.Flreplace - Prlor to faclng
materlals and framlng lnsp.
B Final Building - When ail
requlred lnspections have been
approved and building is
completed.Masonry - Steel locatlon, bond
beams, groutlng.Framlng - Prlor to cover.
Foundatlon - After forms are
erected but prlor to concrete
placement.
Other
WalllCelllng lnsulatlon - Prlor to
cover.
Underground Plumblng - Prior
to fllllng trench.lXl orywall - Prlor to taplng
MOBILE HOME INSPE TIONSUnderlloor Plumblng/ Mechanlcal
- Prlor to lnsulatlon or decklng.Wood Slove - After lnstallatlon
Post and Beam - Prlor to floor
lnsulatlon or decklng.lnsert - After flreplace approval
and lnstallatlon of unlt.
Blocking and Set.Up - Whep all
blocking ls complete.
Floor tnsulallon - Prlor to
decklng.Curbcut & Approach - After
forms are erected but prlor to
placement of concrete.
Plumblng Connecllons - When
home has been connected to
water and sewer.
Sanltary Sewer - Prlor to fllling
trench.Electrical Connection - When
blocklng, set-up, and plurpbing
inspectlons have been approved
and the home is connected to
the service panel.
Slorm Sewer - Prlor to filling
trench.
[--l SiOewalk & Drlveway - After|J excavation is complete, forms
and sub-base materlal ln place.
Water Llne - Prlor to filling
trench.
Fence - When completed
Rough Plumblng - Prior to
cover.
Streel Trees - When all requlred
trees are planted.
Final - After all required
inspectlons are approved and
porches, sklrting, decks, and
ventlng have been installed.
74r - 7o-
E
E
tl
E
tl
tl
E
E
tl
B Final Electrical - When att
electrical work is complete.s
E
E
'.,. trl?,ti ;t
Lot faces
Lot sq. ftg.
Lot coverage
, ,1*,,
Topography
Total tleight
Lot Typ€
v
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Setbacks
P.L,HSE GAR ACC
N
S
E
i- IS THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OB ON
THE HISTORICAL REGISTER?
-
lf yes, thls applicatlon must be slgned
and approved by the H istorlcal
Coordinator prior to permit issuance.
APPROVED:
BUILDING PERMIT
ITEM SO. FT. X $/SQ. FT.
3 2a rt)rzr,t;. ---;€3*(A) / 6 ,?/
VALUE
,a- a -/On "
€a
,a6
T<rtal Value
Building Permit Fee
State Surcharge
Total Fee
Main
Garlage
Carport
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall, in all respects, conlorm 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 ewed By Date
Plan Check Fee
Date Paid:
Receipt Num
Received By:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ITEM
Flxtu rest
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
N0
FT.
FT.
(c)
PLUMBING PERMIT
Plumbing Permit
State_ Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Fireplace Unit
Dryer Vent
(D)
Vent Fan
Mechanical Permit
lssuahce
State:surcharge
Total Permit
MECHANICAL PERMIT
Furnace
Exhaust Hood By slgnature, I state and agree, that I have carefully examined
tho 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
wlth the Ordinances of the City of Sprlngfield, and the Laws
of the State of Oregon pertainlng to the work described
hereln, and that NO OCCUPANCy will be made of any
structure without permission of the Buildlng Safety Division.
I further certlfy that only contractors and employees who
are ln 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 ls readable
from the street, that the permit card ls located at the front
of the property, and the approved set of plans will remain
Date 7-t1-n Y
X,nnu,r,u
on the site at all ti during struction.
MISCELLAN EOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding etecrricat)
(A, B, C, Q and E Comblned)/8^? L
VALIDATION
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
t/l*
FT.
N0
.-..-.-l
5t.r ilN(;l: tt:Lu
2.25 IIII.'TII STRI:
sPtuNGFIliu), 0
INSPIICI'ION REQUIIS'I :
0FPICE: 72.6-3751)
1. LOCA TION OI' INSTALLATION
ono' - !-lj7n1- 3. coHpLETIt pEE
'.IIEDULB
BBLov
/z ri:-a,i $;g,'latur". 4T.-retial-Single or
CAL PBTTHIT APPLICATI ON
Ci ty Job Number
HuIti-Family per duelling unit.
Service Included:
I tems Cos t
1000 sq.ft. or }ess
Each additlonal 500
sq. ft or portlon
t lre reo f
Each Manuf 'd llome or
Modular DweIling
Service or Feeder
$ 8s.00
$ 1s.00
s 40.00
Services or Feeders
Installatlon, Alteratlons or
Relocation:
m
200 amps or less
201 anrps to 400 amps
-
401 amps to 600 amps
-
601 amps to 1000 amps-
Over 1000 amps/volts
-
Reconnect 0nIY
Tie f ..rr,rr47i1-;4 projoct as submftt<r.:r 7c,: ,;i;..!5;:fi17J*"#7j,1}*,fi[tffspuemr
RI.:GON 97477^r't"''.
7?.6-3't69
t
LEGAL DT.SCRI N
JOB DESCRIT'TION
Pernrits arc non-transferable and explre
1f vork is not started vltlrin 180 days
of issuance or if vork ls suspended for
180 days.
2. CO}nru\gTOR INSTALT.ATION ONLY
)Adclr:ess
Ci ty
Supcrvi:;or License Nunrber Z43
Iixpi ra t i otr Da tc
Con:;tr Corrtr. Number o(-l
Iixpiration Datc
Signature o[ Supcrvising Elcctrician
t/t
Ovne rs Natne 73,J,*zr
OVNIIN INS'TALLATION
The installation is being made on
property I ovn vhich is not intended
for sa1e, Iease or rent.
Ovncrs Slgnattrrc:
DATE:
NECEI
Temporary Services or Feeders
Installatlon, Alteration or Relocation
200 amps or less
201 amps to 400 amps _
0ver 401 to 600 amps
-
Over 600 amps or 1000 volts
Sum
D
rircc r r i car con t rac,
"
OnuW)(AiUUflp diro
0050s
(
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
00
00
00
C.
D
E
s 40.
e rBr a66F
$
$
se
55
BO
Arldrcss - _ _ _
city__vr,.".7/6-7GZg
Branch Clrcults
Nev, Alteratlon or Extenslon Per Pane1
Each Addi t ional
Circuit or vith Service
or Feeder Permit
-
$ 2.00
-l'liscellaneotts (Service/feeder not lncluded)
-Each installation
Plrmp or irrigation
Sign/Ou tline Ligh t ing-
Limi ted EnergY/Res
Limi ted EnergY/Comm
SUDTOTAL OP ADOVB
5f State Surcharge+srfir BQ"
3r,'
s
s
s
s
40.
40.
20.
00
00
00
0036
/a
?r
of,
I(Ii(:IiIVI.:D IITI
5
3 7U
rr'o,.'u-l76 -5iD,.?
a,t' ,
w
DO NOT WRITE IN TIIIS SPAC,CONTROL EXP.NO. NO.
District of Incident
3 Firet, MI)
4 BUSINESS Fint, MI)
2 INCIDENTADDRNSS"""iiL fi 12#
County
Radio
E verbat
D NoAlamRec'd
lt/;rlb L
FIRE DEPT.
ALARMNO.
Responding
U Hand-laid hore/hydrant,standpipe
D Mster Stpm Device
E NotClassifiedAbove
Below grd. Ievel
Not Classified
5Ff4'2'.l 87
t
DP
u'
-4-
yu
6 FIREREPORTED BY (Ist,FiEt, MI)
o*"'Y'f"''
7 METHODOF
ALARM
First,
Telephone Dirct
E Mui"i*l ehrm System
E Privat€Alamsyst€m
5
I
2
zo3I
6
7
9ll (Tie Line)
Voie Signal Muni Alarm
a.l
r-t!a
E
U)
U)€
ttE
Ita
9 TYPEOFSITUATIONFOUND
rl Ellst-"trreFire
I ( n other Prcp. w/value
8
'OFFIRERESPONDED
IO METHODOF
EXTINGT]ISHMENT
l5
I v"hi"l"Fir"
n Brush,Grass,teave
! Trrh, Rubbish
E Other(Lisr)
! Automatic Ext. System
El Pre-connect hre/tank only
E NotClrcfiedAbove
Over 70 f@t
in
D S€lf-Extinguished
E Make-shift.aids
n PortableExtinguisher
Undet€rmined
UndetBmined
o
z
'Ut-B€tt
o
!U
t.r.
o(nrj
t.
t5
E
Ita
1,1
arl
!U
o€
r!
E
F
t5
U)
zrr
n!!
tr
tr
tr
ll
M MOBILE
OF FIRE ORIGIN
EQUIPMENT
INVOLVED
IN IGNITION
HEATOF
e
FIRE ORIGIN
level to 9 fftt
VALUE
LOSS
OF STORIES
(In Yem)
TYPE
fl stetc 3-4 hr.
The objet of origin
Part of mm or 8M of origin
Rmm of origin
Fire-rattd comp. of origin
Flor of origin
Structure oforigin
Ertended beyond structure of origin
9 No &roge of the t,"e (N/A)
22 Follow Up lnvetigation
EFP.e-co.n"ct hose/hydret,
/aoc<
10 to l9 feet
20 t 29 fe€t
30 to 49 feet
50 to 70 fet
Hearl,Timber
I Protact. Steel
TO: Flame Smoke
2 stories
3 to 4 stories
5 to 6 storiB
7 to 12 stories
13 to 24 stori6
25 to ,19 storiB
50 starie ot more
l8
l9
1
2
3
4
5
6
7
I
,
3
4
6
7
truV
tr
tr
tr!
Unprot€ct. Ste€l Bldg Unprctet. Maenry Ert. & W@d Int.
E Protet.Ext. & Wmd Int. E Prctectcd Wood Fmme
N
-
If y6, who will invctigata
Wood Frame
E Not Ctasified Above
9E
J !.
23
Fire
24
25 Additioml Information by
MO
?
DAY6 q4YEAR tr
tr
Tuc
Wed
E tr*
fl r;
fl srtu.
Vuon
E srnDAY OF
WEEK
ALARM TIME
/?d 3
ARRIVALTIME
/?dz
TIMEBACK IN
2DYE
ZIP CENSUS TRACT33 ISO CLASS3
DOB (optional)
7 4z/-7? 7fTELEPHONE
ADDRESS DOB (optional)
h^
TELEPHONT'
8a DOB (optional)J-.\,qELEPHONE
ADDRESS H DOB (optional)TELEPHONE
E R.*iu"d E cir"r Wte
(extinguish or investigate only)
# OFENGINES RESPONDED2 # OF AERIAL APPARATUS RESPONDEDo ,l OTHER !'EHICLES RESPONDED
(do not include PA'e.L-r4
E Extincuish
E Invetigation
E Removed Haard
! sturany
TYPEOF TAKEN
Salvage
Not Classified
PROPERTY COMPLEX (If applieble)MOBILE PROPERTY (Cnmplete line M)
MAKE MODEL SERIAL #LICENSE #
EQUIPMENT INVOLVED IN IG .ITION (Complete Line E)
YEAR MAKE MODEL SERIAL #VOLTAGE
TERIAL FIRST IGNITED WAS MADEOF
Y &nr ,4 Aaz
.00 d.N
Vehicle aod Contents
.00
Other
.00
.00 .00 .00 .00 Cfr
10,000'19,999 sq ft 50,000-99,999 sq ft 50O,0O0 sq ft1000-4999 sq ft
W6-sss ft ft ftft
BUILDING SIZE (Grnd FIr Only)
DETECTOR PERFORMANCE
IrEz!sErErfl oEzlaV6
In room oforigin-oper.
Not in rom of origin-oper.
In rm of origin-not oper-fire te sroll
Not in m of origin-not oper. 6re too sull
In room oforigin-not ope!. power di$onnfft
Not in rm oforigin-not oper. power dison.
ln room oforigin-not op€!. ded batt€ry
Not in rmm of origin-not oper. dqd battery
No detector prerent D t0 Und"t ^inud
SPRINKLER PERFORMANCE
Equip. should have oper.-did not
&uip. pre*nt fire te s@ll to oper
Not classified above
E Undetermined or not reportcd
@4 "quip-"rt prsent (N/A)
SprinklereControlledFire: YES E NO E
fl Equipment operated
tr
tr
tr
I of Heads Opened
Other
\umbe!of Faaliti€s
lj€n ice
''YAhh)o,*"?-5- 7//Repon hrria.-,
Title /Date
#PI
814-d40-10 /Fl-nA\
Other
f] ont.onback
I
PROPERTY