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TAX LOT:
SUBDIVISION:
JOB NUMBER
LOCATION Of: PROPOSED WORK:
ASSESSORS MAP:
RESIDENTIAL
PERMIT APPLICATION
lnspections:726-3769
Off ice: 726-3759
225 Fifth Street
Spring field, Oregon 97 477
PHONE
S;=#<,"1 e(L ZIP:STATE
),4OWNER
CITY:
ADDRESS
NEW
-
REMODEL ADDITION DEMOLISH OTHER
{DESCRIBE WORK
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ADDRESS EXPIRES PHONE
Dylee: ?Juubry w.PI.UMBINC
CONTRACTOR'S NAME
CENERAL:
MECHANICAL:
ELECTRICAL:
CONST.
CONTRACTOR #
RANGE
r OF BDRMS:
- OFFICE USE -
ZONING CODE:
trLOOD PLAIN
SECONDARY HEAT:
WATEB HEATER
QUAD AREA:
, OF BLDGS
CONSTR. TYPE
HEAT SOURCE:
LAND USE:
# OF UNITS
SQUARE FOOTAGE:
OCCY GROUP:
r OF STORIES:
To request an inspection, you must call 726-3769. This is a24 hour recording. All inspections requested before 7:00 a.m. will be
made the same working day, inspections requested atlerT:OO a.m. will be made the following work day.
REQUIRED INSPECTIONS
Temporary Eleclric Rough Mechanical - Prior to
cover.
Final Plumbing - When all
plurnbing worl< is complete.
Site lnspection - To be made
af ter excavation, but prior to
setting forms.
Rough Electrical - Prior to Final Electrical - When all
electrical work is complete.cover.
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.
Eleclrical Service - Must be
approved to obtain permanent
electrical power.
Final Mechanical - When all
mechanical work is complete.
Footing - After trenches are
excavated.
Final Building - When all
required inspections have been
approved and building is
completed.Masonry - Steel location, bond
beams, grouting.
OtherFoundation - After forms are
erected but prior to concrete
placement.
Underground Plumbing - Prior
to filling trench.
MOBILE HOME INSPECTIONS
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.Wood Stove - After installation
Post and Beam - Prior to floor
insulation or decking.lnsert - After flreplace approval
and installation of unit.
Blocking and Set-Up - When all
blocking is complete.
Floor lnsulalion - Prior to
decki ng.Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Plumbing Conneclions - When
home lras 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.
Sidewalk & Driveway - After
excavation is complete, {orms
and sub-base material in place.
Water Line - Prior to lilling
trench.
Fence - When completed.
Slreet Trees - When all required
trees are planted.
Final - After all required
inspections are approved and
porches, skirting, clecks, and
venting have lteen installec!.
Rough Plumbing - Prior to
cover.
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E Storm Sewer - Prior to filling
trench.
[-l Fireptace - Prior to faclnglJ materials and framlng lnsp.
l-_l Framing - Prior to cover.
[_-l watttCeiling ]nsulation - Prior tot__-J cover.
f_l Drywalt - Prior to taping.
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Lot faces
Lot sq. ftg.
Lot coverage
TopographY
Total height
Lot Typq
--
lnterior
-
Corner
=- Panhandle
-
Cul-de-sac
Setba<;l<s
P.L.HSE GAR ACC
N
E,
IS THE PROPOSED WORK IN THE
HISTORICAL DISTFIICT, OR ON
THE HISTORICAL REGISTEB?
-
lf yes, lhis application must lle signed
and approved bY t hc Fl i s torical
Coordinator prior to pernlit issuance.
APPROVED:
BUTLDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is grante<i on the express conditiorl that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of Springfield, including the
Development 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.
Receipt Number:=-
Plans ReviewetJ By Date
Plan Check Fee:
Date Paid
Received By
VALUE
(A)
X $/SO. FT
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SO. FT.
Main
Garage
Carport
Systems Development Charge is due on all undeveloped
properties within tlre City limits which are being improved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
ITEM
Fixtures
Residential Bath(s)
Sanitaty Sewer
Water
Storm Sewer
Mobile Home
PLUMBING PERMIT
FEE
N0
4o.oo
40.Db
L-&_
F-t
FT.
FT.
(c)_4L.@
Plumbing Permit
State Surcharge
Total Clrarge
Wood Stove/ lnsert/ Fireplace Uni t
Dryor Vent
(D)
N0Vent Fan
Mechatrical Pertrtit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rnace
Exhaust Flood
By signature, I state and agree, that I have caref ully examined
the completed application and do hereby certify that all
information hereon is true and correct, and I Iurther certify
that any and all work performed shall be done in accordance
with the Ordinances of thc City of Springfield, and ttre Laws
of the Statc of Orcl;cttt 1>crt;rining to thc worl< <lcscribr:d
hcreirr, lrrrtl tlrat NO OCCtJt'1ANCY will br: ttt;ttlc of itrty
structulc witllout pcrtrtission of tl-tc Building Safety Divisiotr.
I further ccrtify th;rt or-rly contractors and ertployeos wl-to
arc in cotnpliance witl't ORS 7O1.055 will bc usc<J on tltis
proiect.
I f urther agree to ensure that all required inspections are
requested at the proper time, that each address is readable
from the street, that the permit card is located at the front
Date
re
of the property, and the aPP roved set of plans will remain
mes NS
",n"t
ionon the site
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-_-
ft
Curbcut
-_
ft
Demolition
State Surcttarge
Total Miscellaneous Permits (E)
RECEIVED BY
AMOUNT RECEIVED
DATE PAID
VALIDATION:
RECEIPT NUMBER
TOTAL AMOUNT DUE (excluding clectrical)
(A, B, C, D, and E Combined)
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