HomeMy WebLinkAboutPermit Plumbing 1999-02-03RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:7
LOT:
SPRINGFIELO
afi,
JOB NUMBER 4f0
225 Fifth Street
Sprlngfleld, Oregon g7 477
O77 oo
TAX LO'I:4W>9 Jc r u
BLOCK: SUBDIVISION
PHONE:
STATE:ZIP:
I (
I
OWNER:
ADDRESS
CITY:
NEW- REMODEL ADDITION DEMOLISH OTHER-
e(DESCRIBE WORK:
ADDRESS I
,lqlcS'Si!o,lo-s
CONTRACTOR'S NAME
PLUMBING:
GENERAL:
MECHANICAL:
ELECTBICAL;
CONST.
CONTRACTOR #
-f/0.t L
EXPIRES 1 PHONE
FLOOD PLAIN: _
ZONING CODE: _
s HALt ex HRF tfTFlE.WOfir(--
o
o
U N D EHqH $pEFN,firF g: N€+--
SQUARE FOOTAGE:WATER HEATER:BANGE:
To request an lnspectlon, you must call 726-3769. Thls is a24 hour recordlng. All lnspectlons requested before 7:00 a.m. wlll bemade the same worklng day, lnspections requested after 7:00 a.m. wlll be macle the followlng work day.
REQUIRED INSPECTIONS
l--l Temporary Etectric Rough Mechanlcal - Prlor to
cover.
Final Plumbing - When altplumbing worl( is complete.
Site lnspection - To lre made
after excavatlon, but prior to
setting forms.
Rough Electrical - Prior to Final Electrical - When all
electrical work.is complete.cover,
Underslab Plumblng/ Electrical /
Mechanlcal - Prior to cover.Electrlcal Servlce - Must be
approved to obtain permanent
electrlcal power.
Final Mechanlcal - When all
mechanical work ls complete.
Footlng - After trenches are
excavated.Flreplace - Prlor to faclng
materlals and framing lnsp.
Final Buildlng - When ail
requlred lnspectlons have been
approved and building is
completed.Masonry - Steel locatlon, bond
beams, groutlng.Framlng - Prior to cover.
Foundatlon - After forms are
erected but prior to concrete
placement.
Other
Wall/Celling lnsulatlon - Prlor to
cover.
Underground Plumblng - Prior
to filllng trench.l-_l Orywall - Prior to taping
Underlloor Plumblng / Mechanlcat
- Prior to lnsulatlon or decking.
MOBILE HOME INSPECTTONS
l-l Wood Stove - After tnstaltation.
Post and Beam - Prior to floor
lnsulatlon or decking.lnserl - After flreplace approval
and lnstallatlon of unlt.
Blocking and Set.Up - When ailblocklng ls complete.
Floor lnsulation - Prior to Plumbing Connectlons - When
home has been connected to
water and sewer.
ing Curbcul & AJrproaclr - After
forrns are erected b(tt prior toplacement of concrete.tary Sewer - Prior to filling
ch.
Storm Sewer - Prior to filling
trench.
Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
Electrical Connection - Whenblocking, set-up, and plumbing
lnspections have been approved
and the home is connected tothe servlce panel.
Water Llne - Prior to filling
trench.l-l Fence - When coi,rpleted
Str€et Trees - When all requlred
trees are planted.
Final - After all requiredlnspectlons are approved andporchcs, sklrting, decks, andventlng have been lnstalled.
Rough Plumbing - Prior to
cover.
I
COT,It{FNNF.N
utitiSSrtceNotificationThose
by the USE _
tl
tl
E
E
E
tl
tl
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type_
-
lnterior
-
Corner
-
Panhandle :
-
Cul-de-sac
ks i-- IS THE PROPOSED WORK TN THE.
HISTORICAL DISTRICT, OR ON
THE HISTOBICAL REGISTER?
-
lf yes, this application must be slgned
arrd approved by the H istorlcal
Coordinator prior to permit issuance.
APPROVED:
PL.ACC}JSE GAR
N
S
E
BUILDING PERMIT
ITEM SO. FT.
Main
Garage
Carport
VALUE
(A)
Total Value
Building Permit Fee
State Surcharge
Total Fee
X $/SQ. FT.
' 't
BUTLDING ViqLUE, PLAN CHECK
AND BUILDING PERMIT
This pernrit 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
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.
Receipt Number:-
Plans Reviewed By Date
Plan Check Fee:
Date Paid
Received By:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within tlre City limits which are being improved.
ITEM
Fixtu res
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
LSN
>7.@
CO?S
(c)
N.
FT.
7d l. L>-
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
. FT.
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
(D)
NoVent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Furnace
Exhaust l-loorj By slgnature, I state and agree, that I have carefully examlned
the completed application and do hereby certlfy that all
lnformation hereon is true and correct, and I f urther certify
that any and all work performed shall be done in accordance
with the Ordinanccs 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 perrnission of the Building Safety Divislon.
I further certify that only contractors and employees who
are in compliance with ORS 701.055 wlll be used on this
proiect.
I further agree to ensure that all reguired lnspections 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 remaln
on the site at all times during constructlon.
-
Date
Signature
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Pennits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, Q and E Combined)
o1 "-7
VAl-IDATION
BECEIPT NUMBER
DATE PAI[)
AMOUNT RECEIVED
RECEIVED BY
FT.
0\/
Y a !Da Di I
47ot
DATE ISSUED:
.PiI,.OAItD
6,
c2/b q
ENCROACH MENT PERMIT
NUMB
226 FIFTH STREET
INSPECTTON LINE SEE INSPECTIONS ON BACK SIDE
APPLIPATION DATE:
PERMIT NUMBER: qr
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISTON
oFFtcE TELEPHONE (503t 726.3763
.LOCATION OF WORK
ZlPt
ONE:
STATE:
EXPIRATION.DATE:
PHONE:
4 E,?AA 5-r
CITY:
ESS:
n STATE: li( -
APPLICANT
SITE ADDRESS:
CITY:
owN
ADDRESS:
rco
FCONTRACTOR REGISTRATION NO:
PROJECT SUPERVISOR:
TAX MAP:
TAX LOT:
hrgPtgTloNt nloutilot A''IJCATOI{ FET
'
OET96IT ACCOUN? NO:
REOUESTED PERM ITS:
tr ENCROACHMENT pERMtT NO: ......... ......................v^rp Fon Stxw tcot o^yt moM oAT! Or Btu^r{ct E t'ao.oo
Q ousr coNrBoL (TypE oF coNTRou
E0_
Q corusrnucroN, sroRAGE srAotNo tr
tr
tr
I
I
t
Q orxen
o ASPHALT OEPOSIT..........
TYPE OF SECURIY NEPOSIT
Q aunrer sunEry BoNo e sunttw eono O cASH / cHEcK EC
t
fl cuna cur pERMlr No!.................... FT. n:q!^E!Y-iEonTffiOAYIMOM DATIOFEGU^IIICA
E 010.00+t.l6/Fr.tflsrF.ron. cunc I erpaoecH AFrER rOnUg
7 ft secoxd( soewau
VALD fion tto
ORIVEWAY ISEE SEPARATE
VALD rOR t!0
PERMIT NO8.................... Ff q.6io.oo*0.16/Fr:,/D.7{O^Y8 FEOM DATTO' BTUANCL
O new E REMovE / BEpAtR e elve PLANT sTRtp
Q'serarcr O cuRBSIDE EJ tINoTH
INsDF'"roN' cloEw^Lx , otlv-EwAY-FOB ALl Collcim ,Av_hto wtmtN THE ITREET ATOHT OF WAy. TO 8EMAoE AFTER ALL cxc^vlrtNo r couru?4,-^ib-i6iiii uroax exo 8u&B sr MATERTAL E $r ?tlcE.Q saruraRy SEWER coNNEcnoN pERMtr:................ r-rVALD FOR stxw taot OAyt FAOM DAT! O, tSgUAlttC! '''-- u-E S5.O'o /
Q ro srua E MAIN LINE (EASEMENT.R/W! e orxen
Q sronru sEwER coNNEcIoN pERMIT: ..............
VALD 70i ElxTy tsot oAya ?frou oATt O' ESUA,{CI
Q cercx BAstN , BuBBlrR e srua e uatNurue
E c6.oo /
PROOF OF INSURANCET 0500,000 MtNtMUMtrArrAcHEo Q neoutneo TOTAL DUE;*I
TOTAL DUE WITH PERMIT C
ITA GATION
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTBUCTION:tr PLANs (TWo sETS)ATTAcHED
AREA: LENGTH:
FROM DATE:
TO DATE:
TIME:
TIME:
IJIIDTH:DEPTH:
BACKFILL MATER}AL:
HEIGHT:
TYPEOFWORK: CUT: QADEe
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEIUTNT MATERIALS TO BE UT]L]ZED:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT
WARNING OEVICES TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UT|IIZED:
DESCRIPTION:
WORK SHALL COMPLY WITH
Adv.nc. rlgnlng rnd work rono prorctton to br ln complltnct wlth thr Mrrurl on Unllorm Trrlllc Cont ol O.vlc.r tUUfCOt
X ARTICLE 6 OF
hEvtstoNs Et21l06 FOnM ' ttc
THE CTTY CODE.COITTRACTOB TO COMPLY WII}I
E_
tr
REVIEW COMMENTS
Ercltlll wlth I'mlnur rocl.
Comprct rvrry 18'loor drpth.
Brqulnr oomp.otlon wlth. .t..1 tolll.r.
A.C. to mrtch th. gnrt.r ol rxlrtlng dlpth or 4'.
All out! t.rlcd lor llnrl lnrprotlon.
T.mpor..y p.tch mty bl ut.d rt thr rnd ol thc drv.
Slgnlng rnd Zonr'grotrctlon to complY wlth MUTco
Cut ooncrcr only on tcotr llnct ot cold tolntt.
Sldrwrlkr rnd ddvrwryr mln 3,000pr1
Curttng mln 3,l0Oprl , No p.tchwott hlr thln 3'.
Mot mh. rcqulrcmcntr on otrt cutt, SPld. cod!.
R.itor. pl!nt.d.cr[r, Spld. codr 206.3.08
Spcc. to 8orc / Jrck / No A.C. crtr.
Mcchrnlcal comprctlng rcqulrcd.
No prtchworl rllowrd.
lrtr[l outt to h!v. aontrol d.n.tty llll.
Cur to bt golymtrlt.d ctrck .trl.d lor llnal lnrpcctlon.
Mlnlnum 2'cruchcd rock I'mlnul.
EXISTINO CITY CODES ANE-fl{ CTTUPUAruCE WITH CURRENT
INSTRUCTIONS:
00t
oo2
009
00.f
006
000
oo7
008
009
or0
011
ot2
013
014
010
0r0
ol7
0r8
0r0
020
o2r
o22
023
024
026
026
o27
028
029
030
031
032
933
343
Commente:
t.
YOU ARE REOUIRED TO CALL
THE LANE UTILIIES COORDINATTNG_ _CQUN9IL',S
"oNE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGINO
INSPECTIONS:
'tr
fiU['ig^';AIf,fl.P,##HiHiBEBIS':+]iJAP'i^lS'i8'13iTJ3,]-iJt'q',It&B'iE!:H-,lWL.iEtBi'y ren -iNsiEcfio[Ii; coliiRA.i.orS
_on
owHeR;S NAME AND PHoNE NUMBER. REOUESTS RECEIVED BEFORE 7:OO A.M. WILL BE
MAbE fXE SAME'OAV, NECiUtSrS IrrER 7:OO A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE
CALr-Eo tN AFTER EichVenorus ARE MADE AND FoRM woBK rs rN pLAcE BUT PRIoR To PouRlNG CONCRETE.
I santrnny sEwER, sToBM sEwER, ENCROACHMENT PERMTT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
7248761.
t furthor rqroo to onsurc that alt roqulrcd lnspectlons are rgqu&ted a.t the proper.time, that project
and the ap-proved set of plans wlll rer,naln on tho Eito at all tlmes duflng constructlon.
I
SIGNATURE:
{
o
Date
7
ceth€andand
to
on
r1600n
761.0sncoaro
7
I have
eus
RECEIVED BY:
AMOUNT RECEIVED:
from the street,
I
DATE PAID:
RECEIPT NO:
address ls readablev
VALIDATION:
I rnarnc REVTEWED BY:
E uetmrENANcE:
[-l penvrr tssuED BY:
FOB SIDEWALK AND CURB CW PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.
I DATE:
WORK IN PROGRESS
AT TIME OF COMPLETION:
DATE:
DATE:
DATE:
OEPOSIT RETURNED:DATE:
DATE:
DATE:
DATE:
DATE:
INSPECTION:
INSPECTION:
I eHcrrueERtNG REVIEWED BY:
Mlnumum 4' chlrtncl at rny polnt, lwing'!w!Y,
Concr.t. mlnlmum 4' dcPth, 3,@OPrl.
Tranch to ba T' out. t
Nccdr St!t. / CountV pcrmlt.
No rbovr ground onctorlngl ln lldcwalk ot hsndlcrp trmpt'
Dlcmond c1,t A.C./Concrct. vlluc boxcr to gradc.
Frorh Oll rlgnr / Gtadcd.
Comply wllh Amrrlcanr wlth Olrlbllltirr Act'
Concrtta rlabr, 72hrl. cudng tlmc, 46o0psi,
Concrrtr rlrbr toqulrc tolnt tcll mtttrl!|.
Drlvrwry rcqulnt dowrlt rvcry 18'.
Submlt tnlllc control plan prlor to cxcrvrtion,
Notlly Trrlllo Dlvlrlon bclorc cxcavatlgn.
Corc drlll mrln llnc, lnrcrt tcc, 2% min. gradc.
Murt comply wlth th. provlrlonr of ORS 757.541 to 757.671.
6' Ckcuhr holc/li2O.Vrc.