HomeMy WebLinkAboutPermit Building 1994-12-08RESID ENT,A LPERMIT APP LICAI,ON
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Office;
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JOB NUMBEFI 9 vl
LOCAT,ON OF PROPOSED WORK:
ASSESSORS MAP:
LOI
To request an lnspecilon, you must callmade the same worklng day, lnspection
lFl r"-Rorary Etectrtc
[--l Underslab ptumbtng/ Etectrical/
-
Mechanlcal - prloi to cover.
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225. Fifth StreetoPrtngfleld, eregon g7477
BLOCK
TAX LOI
---
SUBDIVISION
726-3769. Thls ls a 24 hour recording. Ailrs requested af ter 7:00 a.m. will be made
REQUIRED INSPECTIONS
ffi Rough Mechanical - prior to
-- cover.
ffi Rough Electrical - prior to
-
cover.
ffi Electrical Service - Must be
-
approved to obtain permanent
electrlcal power.
[-l Flreptace - prtor to factng
-
malerlals and framlng lnsp.
W Fr" lng - Prlor to cover.
lff WalltCet[ng tnsutarion - prlor tou cover.
[Tl Drywall - Prlor to taping.
inspeclions requestecl before 7:00 a.m.wlll bethe following work day.
ffi rinat ptumbing - When ail
-
plumbing worl( is complete.
ffi final Electrical - When ail
-
electrical work is complete.
w Final Mechanicat - When allmechanical work ls complete.
fV rinat Buitding - When aila required lnspections have beenapproved and building iscompleted.
l orher 4* | **
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MOBILE HOME INSPECTIONS
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Footlng - After trenches are
excavated.
Masonry - Steel locailon, bondbeams, groutlng,
Foundallon - After forms are
erect€d but prlor to concrete
placemont.
Underground Plumblng - prior
to fllllng trench.
Underlloor Plumblngl Mechanlcal
- Prlor to lnsulatlon or decklng.
Posl and Beam - Prlor to floor
lnsulatlon or decklng.
Floor lnsulation - Prlor to
decklng.
Sanltary Sewer - Prior to filling
trench.
Slorm Sewer - Prior to lilling
trench.
V'later Llne - Pr\or to ti\\ing
trench.
Rough Plumbing - Prior to
cover.
ffi Siaewulk & Driveway - Afters excavation is complete, forms
and sub-base material in place.
Wood Slovo - After lnstallation.
lnserl - After flreplace approvql
and lnstallatlon ol unit.
Curbcut & Approach - After
forms are erected bUt prior toplacemcnt of concrelo.
Fence - When completed.
Slreet Tr€es - When all requlred
trees are Planted.
Blocking anO Ser.Up - When altblocklng ls complete.
i
Plumbing Connections'- When
home has been connected lo
water and sewer.
Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the horne is connecled to
the service panel.
Final - Alter all required
inspections are approved and.
porches, skirtlng, decks, and
ventlng have been installed.
I
PHONE:
STATE:
<-'7 q
ZIP:?77r
.2
CITY:
ADDRESS:
OWNER:
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ADDITION DEMOLISH OTHEFI
DESCHIBE WORK:
NEW )' BEM9DEL
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It
\ffiHsS
CONTBACTOR'S NAME
GENERAL:
PLUMBING:
MECHANICAL:
ELECTRICAL;
ADDFIESS
PHONE
CONST.
CONTRACTOR #
I
5RNl.jJ
F G
_ OFFICE USE _
WATER HEATER:
LAND USE:
ZONING CODE:
/ OF BDRMS:
RANGE:
SECONDARY HEAT:
SOUARE FOOTAGE
* OF UNITS:
'\.
FLOOD PLAIN
OCCY GROUP:
r OF STORIES:
OUAD AREA:
r OF BLDGS:
CONSTR. TYPE:
HEAT SOURCE:
I ')Y
I-_l Site lnspection - To be made.4 after excavatlon, but prior tosettlng forms.
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, - \n " .t: li-:,l,l (
\r{, THE PROPOS ED WORK tN THE '
' HlsroRlcAL DlsTRlgt'OR ON
THE HISTOBICAL REG ISTER?Lot laces
Lot sq. ftg.
Lot coverage
TopograPhY
Total helght
t*tflo
Lot TyPe
rio rnte
Corner
x
*a*oBs
lf yes, this applicatlon must be slgned
"iO'uPPtoruO
bY the Historical
Coordinator prior to permit issuance'
-
Panhandle
.__ Cul'de-sac
VALIDATION:
RECEIPT NUMBER
DATE PAID
,4W,,+AMOUNT RECEIVED
APPROVED:
TOTAL AMOUNT OUE(A,B,qeandECom
P.L.HSE GAR ACC
N z
S ?o ,
W
,?
E (/
BUTLDING VALUE, PLAN CHECK
ANb BUILDING PERMIT
Date
Receipt Numbe
Date Paid
Becei
/ /zf7J-
u ^.2,17 W=(A) ffr.37
BUILDING PERMIT
VALUE
,/o/ laa/*oo // /5(e l/€t t
SO. FT. X $/SQ' FT'ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
Charge is due on all undeveloPed
properties withln the City limits which are being improved
ystems DeveloPmentSYSTEMS DEVELOPMENT C
(B)
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
PLUMBING PERMIT
707.?/
a2-rr>
FT.
FT,
FT.
#
(c)
q / 9Dc:
FEE
Plumblng Permlt
State Surcharge
Total Charge
ADDITIONAL COMMENTS
/.?b
a, at^
s22<
12 --
&6
4?sit7r*c?
(D)
t',e
Mechanical Permit
lssuance
State Surcharge
Total Permit
/ .74I ,/q
4?,e?
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
Wood Stove/ln
Dryer Vent
No=
,tC.*
-#1=
4)
By slgnature, I state and agree, that I have caref ully examlned
the completed application and do hereby certify that all
lnformation hereon is true and correct, and I f urther cerilty
that any and all work performed shall be done in accordance
wlth the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertainlng to the work descrlbed
herein, and that NO OCCUPANCY will be made of any
structure wlthout permission of the Buildlng Safety Divislon.
I further certify that only contractors and employees who
are in compliance with ORS 701.055 will be used on this
proiect.
I further agree to ensure that all required lnspections are
requested at the proper time, that each address is readable
from the street, that the permit card ls located at the front
of the property, and the approved set of plans will remain
Slgnature
Date
/L-
on the site at all ti during constructlon.
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewark /bO t,
curbcut -1ftaq p/z/y *t4?za
Oemolition
State Surcharge
37.6-
ary
-€-
/e*&,>1.r
(E)
Total Miscellaneous Permits
(excluding electricat)
blned)
BECEIVED BY
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Noz
3
...........-.
.?zf-
-a[.r.CITY OF OREGO'U
SPRII LD
225 PIIrTE STREEf,
7?pproval'SPRINGPIEIJ), oREGON 974
INSPECTION REOUEST: 726-3769
0PPICB: 726-3759
H,H:Sl%Bt?X'1'?HXII$""1'li:t'X8
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EI^ECTRICAL PERHIT
City Job Nunber
APPLICATIONq4\535
uEe
SCEEDTII^B BELOU1
A
c
P/o)
Nev Residential-Single orHuIti-FamiIy per dvelling unir.Service Included:
I tems Cos t
B. Services or Feedersfnstallation, Alterationsor Relocation:
1000 sq.ft. or less
Each additional 500sq. ft or portion
thereof
Each Hanufrd Home or
Modular Dvelling
Service or Feeder
D. Branch Circuits
E
STIBTOTAL OP ABOVE5f State Surcharge
TOTAL
$ 8s.00
$ 1s.00
$ 40.00
00
00
80. 00
ee .Brr aEoTe-
A
Sum
8S
&DPermits are non-transferable and expireif vork is not started vithin 180 diysof lssuance or if vork is suspended ior180 days.,
2. CONTRACTOR INSTALINTION ONLY
ElecLrleal Contractor
ELECIRIC
Address PO BOX A 726-7895
ci Phone
Supervisor License Number .L -7->.
Explration Date o-
Constr Contr. Number o-
Expiration Date to -q )
Slgnature of Supervlsing Electrician
Owners
Address
200 amps or less
201 amps to 400 amps
-
401 amps to 600 amps
-
601 amps to 1000 amps-0ver 1000 amps/volti
-Reeonnect Only
200 amps or less ?,.-201 amps to 400 amps
-Over 401 to 600 amps
-Over 600 amps or l000ET[s
Temporary Services or'Feedersfnstallation, Alteration or Relocation
L
00
00
00
00
00
00
$300
$40
$so
$oo
s100
$ 130
s
$
s
s
s 40.00
s 40.00
s 20.00
$ 36.00
40.
55._4o,o,
ci,v-SDf,nd- phone l2q.-l30- trTU
OUNER INSTALI.ATION
rstallation is beirig made on'y I own vhich is not intended. Iease or rent.
ature:
Nev, Alteration or Extension per panel
One Circuir $ 35.00Each Addi tionalCircuit or vith Serviceor Feeder permit _ $ Z.OO
Miscellaneous (Service/feeder not included)-Each installation
Pump or irrigation
Slgn/OutIine Light ing-
Limi ted Energy/Res
-
Llmited Energy/Comm *#_
--T'75-
,7 5
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VICINITY MAP
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Permit No.
I (installer's name)
and Mercury Float
zto
form cS5-11
Tax Lot F€7-
Block _
Total Length of Lines rO ',
toN:
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3?28-?/Twnshp. t7 Range O3 Section
MUST BE IN BLACK INK a
Standard System )z(ntt"rnutire (s
Job Location (Street Address)
Supdivision/Partition #Parcel Lot
DE LAN AS CONSTRUCTED
uo'rk
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PSoee
Diuisrb,o ?t 'r/f-A
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USE BLAC INK ONLY
FOR INSTALLER'S USE Trench Depth 6 G Depth 6"
Tank Capacity /oaD Manufacture t'r1
Measured Distance from Well to Tank
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From Drainfield tz a-fe.^-
USED ON THIS INSTALLAT
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COMPLETE THE FOLLOWING IF A PUMP WAS
certify that a (Mfg.)(Model No.)_- pump
Switch (Mfg. and No.)-------..--have been installed with this sewage installation
Date
-
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:
FOR SANITARIAN'S USE LY:System
COMMENTS
(L System Capacity gal.lday Signature
INSTALLATION BECORD & CEBTIFICATE OF SATISFACTORY CO
dence as per ORS 454-665 of satisfactory completion of a subsur
TMPLETION When signed by the County Sanitarian. this certificate is evi_rlace sewage disposal system at the above location.
Date
Date
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To request inspection, return all three (3)
Public Service Building, 125 E. 8th Aven
copies of this form to: Lane County Environmental Health Services. Iocated in the basement of therue, Eugene. OR 97401,
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