HomeMy WebLinkAboutPermit Mechanical 1993-08-239r
SPRI1.lGFIELE,
RESIDENTIAL
PERMIT APPLICATION
lnspectlons: 726'3769
Office: 726'3759
JoB NUMBE " ?= lz 7?
225 Fifth Street
Springfield, Oregon 97477
A
LOCATION O F PROPOSED'WORK:
ASSESSORS MAP:TAX LOT:
LOT:BLOCK:SUBDIVISION
To request an inspection, you must call 126-316g. This is a 24 hour recording. All inspections requested before 7:00 a.m. will be
made the same working day, inspections requested after 7:00 a.m. will be made the following work day'
REOUIRED INSPECTIONS
f_-l Temporary Electric
ll
Sile lnspection - To be made
af ter excavation, but prior to
setting forms.
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.
Footing - After trenches are
excavated.
Masonry - Steel location, bond
beams, grouting.
Foundation - After forms are
erected but prior to concrete
placement.
Underground Plumbing - Prior
to filling trench.
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.
Post and Beam - Prior to floor
insulation or decking.
Floor lnsulalion - Prior to
decki ng.
Sanitary Sewer - Prior to filling
trench.
Slorm Sewer - Prior to filling
trench.
Waler Line - Prior to filling
trench.
Rough Mechanical - Prior to
cover.
Rough Eleclrical - Prior to
cover.
Electrical Service - Must be
approved to obtain Permanent
electrical power.
Fireplace - Prior to facing
materials and f raming lnsP.
Framing - Prior to cover.
Wall/Ceiling lnsulation - Prior to
cover.
l-l orywall - Prior to taping
lnserl - After f ireplace approval
and installation 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 - When completed.
Street Trees - When all required
trees are planted.
Final Plumbing - When all
plumbing work is complete.
Final Electrical - When all
electrical work is complete.
w Final Mechanical - When all
mechanical work is complete.
Final Building - When all
required inspections have been
approved and building is
completed.'
Other
MOBILE HOME INSPE TIONS
Blocking and Set-Up - When all
blocking is complete.
Plumbing Conneclions - When
home has been connected to
water and sewer.
Electrical Conneclion - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
Final - After all required
inspections are approved and.
porches, skirting, decks, and
venting have been installed.
PHONE:
OR ZIP:STATE:
LJ
+IU <:'(q.7 (/,7 ,1
CITY:
ADDRESS
OWNEFI:
NEW
--
REMODEL ADDITION DEMOLISH OTHER
Pft L{*GbtR6s")E.fiY ttU 6 LEerile 0ooud6L 6fts
treY'(-,LDESCFIIBE WORK:
EXPIRES PHONEADDRESS
8ss '1\aa oo
CONTRACTOR'S NAME
MECHANICAL
CONST.
CONTRACTOR #
G EN ERAL:
PLUMBING
RANGE
'' OF BDRMS
_ OFFICE USE _
FLOOD PLAIN:
ZONING CODE
SECONDARY HEAT:
SQUARE FOOTAGE:
OUAD AREA:
, OF BLDGS
CONSTR. TYPE:
HEAT SOURCE:
LAND USE:
# OF UNITS
OCCY GROUP:
* OF STOFIIES:
Rough Plumbing - Prior to
cover.
/c+7-u *rB a/y'6D
-
Wood Slove - After installation.
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WATER HEATER:
r
Lot faces
Lot sl. ftg.
Lot coverage
Topography
Total height
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
e bac ks
P.L.HSE GAR ACC
N
J
E
IS THE PFIOPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER? _-_
lf yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED
VALUE
(A)
X $/SQ. FT
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carport
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of Springfield, including the
Developmenl 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.
Plans Rcvlewed By Date
Receipt Numbe
Plan Check Fee
Date Paid
Received By:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Developmeni Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
(t)
N0
FT.
FT.
FT.
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
Wood Stove/ lnsert/ Fireplace Unit
(D)=<5
N0
a.*
2-*
Vent Fan
&€Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Furnace
Exhaust Hood
72rr' /f-*
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that all
information hereon is true and correct, and I f urther certify
that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
I further certify that only contractors and employees who
are in compliance with ORS 701.055 will be used on this
project.
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
I
of the property, and the
construc nuri
proved set of plans will remai,,
S ig natu re
Date
on the site at all
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)a-1V-7>
RECEIVED BY
DATE PAID
AMOUNT RECEIVED
VALIDATION:
RECEIP"I- NUMBER
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
ow,-' ,, -
.=/^-- i00L$
OREGO'UC'TY OF
^'":64 nrnlar, as submttted has the foll
seniitcrreuo
,CAL PBRT{IT APPLICATION
s see ll
225 PIFTE STRBBT
SPRTNGPIEIJT, OREGON
INSPECTION RBQTIEST:
OPPICE: 726-3759
TI
974
72
77
6-3769 t.9 Ci ty Job Nunber QV./Z 7?t -27_12 3. COXPIJTE PEB SCEEDT'LE BELOS
1 OP INSTALIATION
JOB DBSCRIPTION
Permi ts are non-trans ferable and expire
if vork is not started vithin 180 days
of lssuance or lf vork ls suspended for
180 days.
2. CONI?ACTOR INSTALIJ\TION ONLY
Electrical Contractot C t.\ €0oq["ril .9frC
Address 7,
ci Phone'l*l-**3a
Supervisor L cen se Number lbgbS
Expiration oate lO - I -95
Constr Contr.. Humber C38rP{
Expiration Date q-t-13
Signat of trician
Ovners Name
Address
ct ptrone'146 - 8505
OgNBR
tial-Single or
MuIti-FamiIy per dvelling unit.
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dvelling
Servlce or Feeder
$ 8s.00
s 1s.00
$ 40.00
c
Sum
00
00
B" aEE
B. Services or Feeders
Installation, Alteiations
or Relocation:
200 amps or less
201 amps to 400 amps
-401 amps to 600 amPs _601 amps to 1000 amps_
0ver 1000 amps/volts
Reeonnect Only
c.
s s0.00
s 60.00
$100. 00
$130.00
$300.00
$ 40.00
$
$
$
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or Iess
20L amps to 400 amps
-0ver 401 to 600 amps
0ver 600 amps or 1000 voT[
40.00
55
80
The installatlon is being made on
property I own r,rhich is not intended
for sale, lease or rent.
Ovners Signature:
D. Branch Circuits
Nev, Alteration or Extension Per Panel
'one circuit I $ 3s.oo X@
Each Additional
Circuit or with Service
or Feeder Permit $ 2.00
E Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/0utIine Light ing-
Limited Energy/Res
Limi ted Energy/Comm
SUBTOTAL OP ABOVB
5Z State Surcharge
TOTAL
35. oo
l,'15
$ 40.00
$ 40.00
$ 20.00
$ 36.00
DATE:
RBCBIVBD
-2
5
3 b.4.5
I.EGAL DESCRIPTION/V*z f, //aa