HomeMy WebLinkAboutPermit Mechanical 1992-10-15RESIDENTIAL
PERMIT APPLICATION
lnspections: 726.3769
Office: 726-3159
ASSESSORS MAP:
OWNER:
- -G
ADDRESS: _____
CITY;
DESCRIBE WORK -L^,q
5
SP,r ELE)
JOB NUMBER q)lq a
225 Fltth Street
Springfleld, Oregon g74ll
LocATtoN oF pRoposED woRK: ____3] I N tbf,J
TAX LOT:o -7)()
BLOCK:
-
SUBDIVISION:
+h PHONE:1 q l-oL( I
s
STATE:a$?lxrztP 7
a e -r eNEW ---- REMODEL ADDITION DEMOLISH OTHER
CONTBACTOR'S NAME
CEN ERAL:
t,I-tJMRINC:
M EC HAN rcA t, fllal*tLo( \:__ H_<"-t .r Y 1tt1 e
EL.t:CTRICAL Q-*€LectL tq
s[r ."-s7 o\
ADDNESS CONST
CONTRACTOR #EXPIRES PHONE
L3 -LV -t
QUAD AREA: __
r OF BLDGS: _-
OCCY GROUp: _
r OF STORIES: _
WATER HEATER:
To request an inspectiorr
made the sanre working
/I OF UNITS:
CONSTFI. TYPE
HEAT SOURCE:
FIANGE:
Rough Mechanicat - prior tocover.
Rough Electricat -- prior tocover
FLOOD PLAIN:
ZONING CODE:
* OF BDRMS:
SECONDAFIY HEA'I:
SQUARE FOOTAGE:
ions requested before 7:00 a.m. wlll beowlng wor,( day.
, you rnust c:aii 126-376g. This is a ?4 rlo,.tr recorcllng. Allday, inspcctions requested after 7:00 a.m. wlll be macje
REQUIRED INSPECTIONS
lnspect
the folt
Sile lnspeclion - To bc rnadr,.af lcr excav;rtion, but prior t()setting lorilts.
[-_| Understab plumbing/Etectricat/lJ Mechanical - prioi to ""rui.-"
[-l Footing - After rrenches are'---- cxoavatcd.
[l frlasonry - Steel tocation, t)on(,
-
oearnsr groutino.
Temporary Eteclric
Foundalion - After forms areerected but prior to concreteplacement.
Post and Beam - Prior to floor
insulalion or decking.
Floor lnsulation - Prior to
decki ng.
Sanitary Sewer - Prior to lilling
trench.
Slorm Sewer - Prior to filling
trench.
Water Llne - Prlor to (illingl
trench.
Rough Plumbing - Prior to
Eleclrical Service - Must beapproved to obtain permanentetectrical power.
l--l rinal ptumbing _ When ail
-.
prumbing worl( is complete.
Final Eleclricat - Wllen atlelectrical work is complete.
Final Mechanical _ When allmechanical work is complete.
Final Bultding - When ailrequlrecl .lnspecilons have br..enapproved ancl builcling iscomplete(,.
[
-f Firentace - prior to ,a(:lnU
-
rrralerl:rls an<l framlng lnspl
[-_l Framing - prior to cover.
Olher
Underground Plumbinq - prior
to filling trench. - L_l Drywall - Prlor to taping
fl Underlloor Ptumbing/Mechanicat.- .- Prior to insulation or clecking.
Wall/Ceiling lnsulation _ prior tocover.
Wood Stove - Afler Installation
lnserl - After flreplace approval
and lnstallation of unit.
Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Sidewalk & Driveway - After
excavation is comPlete, forms
and sub-base material in Place.
Fence - Wlren conlPleted.
Street Trees - When all required
trees are Planted'
MOBILE HOME INSPE TIONS
[-_l Blocking and Set.Up - When ail
-
blocking ls complete.
Plumbing Connections - Whenhome has been connected towater and sewer.
Eleclrical Connection - Whenblocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the servlce panel.
Flnal - After all requlred
lnspections are approved and
porches, sklrting, decks, and
ventlng have been installed.
cover.
LOT.
3
_ OFFICE USE -
LAND USE:
I_i
il
r
n
a
tl
En E
Lot faces
Lot sq. ftg.
Lot coverage
ToPograPhY
Total height
Lot TYPe
-
lnterior
--.-. Corner
-
Panhandle
-
Cul'de'sac
PL.HSE ACC
N
S
E
Date
B veweRcviNSP
VA KCEHcNALPELUGNLDUBTMREPGNDLUB dDSAANlret1:llrodisconexl-rc predo11rant ecnannl0()ttllleStoTltINpcIconf ortSrcarlnspec hehalSoril1duncrUgltcdconstenilsCpoo{Ci v euscItanclonbyderUCoNSptadoohe:lt t1 sodCregue,rneneniltdanyokeprDevelrevooedndSSUpebednrays.an arln cerddinoUIgsbSaidoion2\provisny
Received BY
ReceiPt Numbcr:- --
upon violation ol
Plan Check Fee:
Date Paid:
(A)
x $/so. FT'
Total Fee
BUILDING PERMIT
ITEM SO' FT'
Main
Garage
CarPort
Total Value
Building Permit Fee
State Surcharge
edopdeveIIUaloneSUdCCl.t at gloevepmenDS rovcdtemmSpystewl't cltSmticct l.t vnrhtertIOpepT CHARGE (SDC)
(B)
SYSTEMS DEV ELOPMEN
'_Q,,l-
Vn r Lr,-Lfua
ADDITIONAL CO MMENTS
ITEM
Fixtures
Residential Bath(s)
SanitarY Sewer
Water
Storm Sewer
Mobile Home
NO
FT.
FT,
FT.
(c)
PLUMBING PER MIT
Plumbing Permlt
State Surcharge
Total Charge
Wood Stove/ lnsert/ Fireplace Unit
DrYer Vent
.!5-15(D)
,-)<
MECHANICAL PERM IT
Furnace
Exhaust Hood
Vent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permlt
By signature, I state ancl agree' that I have carelully examined
the completeO uppf ituUJn and do hereby certily that all
irrformation hereon '"
;;;; und "o"e"t'
and I f urther certi(y
that any and all *o'k p"'fo'med shall be done in accordance
with the orclinances oiti't" Citv of Springf ielcl' and the Laws
of tlle Statc of O'"tlt".r"p"'taining to the. work clcscribccl
lrcrcirr, atltl tlrrtt r'ro cliCLrpANCY will br: trtttdr: ol atry
structLrre witlrout O""ntOt't'n o( ttre Builcling Satety Division'
I f urther ccrtify tn't t"''i' contractors ancl .r:rrtployees
wlro
are lt't cotnpfion"" *lti' ORS 70l'O55 will t.tc used on tlris
proiect
Signatu re
Date --=..--
rol Ci
\
t all reqtrirecl insPections are
I f urtlrcr agree to crrsute tha
that each adclress is readable
requested at the ProP(lr timc'
it card is located at the (ront
from the street, that thc Perm
ed set of Plans will remain
o( the ProPertY, and thc aPprov
construction'd u ringon tlre site at all t
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ll
Curbcut
-
ll
Demolition
State Surcharge
(E)
MISCELLANEOUS PER MITS
Total Miscellaneous Permits
VALIDATION:
RECEIPT NUMBEFI -
DATE PAID
AMOUNT RECEIVED
RECEIVEO BY .-. --
:-sr.<o -
u{q0
+
-- AA
11,=
TOTAL AMOUNT DUE (exclud
6, B, C, D, and E Combined)
l<-sing electrical)
ii rnr PRoPoSED WOBK IN THE
ll lsTORICAL DISTRI CT, OR ON
TI-IE HISTORICAL REG ISTER?
lf ye s, this aPPlication must be signed
ancl apProved bY tlre Historical
Coorcjitrettor Prior to pr-.rmit issuance'
APPBOVED: -
VALUE
being
F-
FEE
F-
No
'!ca *l<')soo-
)DAo
st"taN(;FtEL(,
!
225 FTFTB STREET
SPRTNGFTELD oREGON 97477
lj;,,tgr5gg"ffi atu
INSPECTION REQUBST: 126-3769OPPTCE: 72G-3159
PERilTT APPLTCATION
3. COHPLBTE TEB SCEEDULE BELOY
-Sing1e orHuIti-Family pe r dvelling unit.Service fnclud ed:
f tems
1,000 sq.ft. or less
Each additional 500sq. ft or portion
thereof
Each Manufrd Home or
-
Modular Dwelling
Service or Feeder
B. Services or Feedersfnstallation, Alterations or. Relocation:
c.
,
1. LOCATTON OP INSTALLATTON,uthorized Sig
LEGAL DESCRTPTION .:7o o
JOB DESCRTPTTON
Add ress Po.*s
cit Phone t-t\3 b
Supervisor L cense Number lb g6E
Expiration Date l0 * I -Ov,\)
Constr Contr. Number
ExpirationDate q-l-q.q
Signature of Supervising Blectrician
0vners Name
Address
200 amps or less $ 5O.OO
401 amps to 600 amps
-
gloo.o0
601 amps to 1000 amps- g13o.o0
over 1000 amps/volts
-
$30o.oo
Temporary Services or FeedersInstallation, Alteration or Relocation
200 amps or less S 40.00
201 amps to 400 amps
-
g 55.00
over 401 to 600 amps
-
$ go.oo
Over 600 amps or 1000Erfs see "Bu aEiG-
Cos t
s 8s.00
s 1s.00
s 40.00
Sum
Permits are non-transferable and expireif vork is not started vithin iAO a"y"of issuance or if vork i" "u.p"nded for180 days.
2. COMrRACTOR INSTALT,ATION ONLY
Electrical Contractor C d,f F 0o nr,ir n ,, CIrrn
D. Branch Circuits
Nev, Alteration or Extension per panel
Ci ty Phone 14,1-o*at
OIINER INSTALI,ATION
The installation is being made on
property I ovn vhich is not intendedfor sale, lease or rent.
Ovners Signature:
DATE:
RECEIPT *:
one Ci rcui t I $ 35.00 35.CoEach Addi tional
Circuit or vith Service
or Feeder Permit S 2.00
E. Miscellaneous (Service/feeder
-Each installation
Pump or irrigation $Sign/Outline Lighting_ S
Limi ted Energy/Res SLimited Energy/Comm $
not included)
40.00
40.00
20.00
5 STIBTOTAL OF ABOVB
5X State Surcharge
TOTAL
35 .oo
I tl<l. r I uI
RECEIVED BY:
3b,t15
, ELEGTAICAL
city Job xu u", 72 //#
s,l,q
nirnnLt I
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