The URL can be used to link to this page

Home My WebLink AboutPermit Plumbing 1994-09-01ESIDENTIAL ERMIT APPLICATION SP]lINGFIELO B P q_,e JOB NUMBER 225 Fifth Street Springfleld, Oregon 97 477 -1Ss- lnspections: 726-3769 Office: 726-3759 LOCAtrION OF PROPOSED WORK: ASSESSORS MAP; LOT -J-z </4Z-/ - n Llv n L, TAX LOT BLOCK:SUBDIVISION ,/r-l{ STATE:ZIP: STx). /-5b CITY: ADDRESS: OWNEF: NEW - BEMODEL ADDITION DEMOLISH OTHER -- DESCRIBE WORK: ADORESS EXPIRES PHONE 4 6 6v<, CONTRACTOR'S NAME GENEBAL: ELECTBICAL: MECHANICAL: PLUMBING: CONST. CONTRACTOR # RANGE: FLOOD PLAIN - OFFICE USE - LAND USE: * OF UNITS:ZONING CODE: ,Y OF BDRMS QUAD AREA: I OF BLDGS: WATER HEATER: OCCY GROUP: * OF STORIES:SECONDARY HEAT: SQUARE FOOTAGE: CONSTR. TYPE: HEAT SOURCE: To request an lnspectlon, you must call 726-3769. Thls ls a24 hour recordlng. All lnspections requested before 7:00 a.m. wlll bemade the same worklng dax lnspectlons requested after 7:00 a.m. wlll be made the following work day. REQUIRED INSPECTIONS Temporary Eleclrlc Rough Mechanlcal - Prlor to cover. Final Plumbing - When allplumblng work ls complete. Slte lnspectlon - To be made after excavatlon, but prior to settlng forms. Rough Electrlcal - Prlor to Final Electrical - When ail electrical work is complete.3cover. Electrlcal Servlce - Must be approved to obtaln permanent electrlcal power. Flnal Mechanical - When all mechanlcal work is complete. Flreplace - Prlor to faclng materlals and framlng lnsp. Flnal Building - When all requlred lnspectlons have been approved and building is completed. Framlng - Prlor to cover. Other Wall/Celllng lnsulatlon - Prlor to cover. l--l Drywall - Prior to taping MOBILE HOME INSPECTIONS Wood Stove - After lnstallatlon lnsert - After flreplace approval and lnstallatlon of unlt. [-_l Blocking and Set.Up - When ail - blocklng ls complete. Curbcut & Approach - After forms are erected but prlor to placemont of concrete. Plumbing Connectlons - When home has been connected to water and sewer. Electrical Conneclion - When blocking, set.up, and plurgbing lnspectlons have been approved and the home is connected to the service panel. Slorm Sewer - Prlor to fllllng trench. Sidewalk & Drlveway - After excavation is complete, forms and sub.base materlal ln place. l--l Water Llne - Prlor to fiiling 'J trench. [---l Rough Plumblng - Prior toU cover. Fence - When completed Slr€et Trees - When all requlred trees are planted. Final - After all required inspections are approved andporches, sklrting, decks, andventing have been lnstalled. /9.d Qrz.-/ z a PHoNE: i; 7- *^/ Z E E I-_| Underslab Plumblng/ Electrical / - Mechanlcat - Prlor to cover. l-l Fooflng - After trenches areIJ excavated. [-l Masonry - Steel locatlon, bondH beams, groutlng. l_l Foundatlon - After forms are|J erected but prlor to concrete placement. [-l Unaerground Plumblng - Prioru to fllllng trench. I-_l Underlloor Plumblng/ Mechanlcal Prlor to lnsulatlon or decklng. [-_l Post and Beam - Prlor to floor|J lnsulatlon or decklng. [--l Floor lnsulatlon - Prlor tolJ decklng. ffiSanltary Sewer - Prlor to fllling z,,Ia(rtrench. tf E E tl .{i i Lot faces Lot sq. ftg. Lot coverage Topography Total [eight Lot Typ - lnterior - Corner - Panhandle - Cul-de-sac APPROVED: RL.HSE GAR ACC N S W E VALUE (A) X $/SQ. FT. Garage Carport Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SQ. FT. Main BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT Thls permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordlnance adopted by the City . of Springf ield, including the Development Code, regulating the construction and use of bulldings, and may be suspended or revoked at any time upon violation of any provisions of sald ordlnances. Fleceipt Number:- Revi ByP Date Plan Check Fee: Date Paid SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. Sanitary Sewer Fr. Z / #>ry Water FT. FEE (c) 7b *lpttQr---7,2a/,3,* N0 FT. Z^DA PLUMBING PERMIT zole Plumbing Permit State_ Surcharge Total Charge ITEM FixLures Residential Bath(s) Storm Sewer Mobile Home ADDITIONAL COMMENTS Wood Stove/ lnsert/ Fi replace Unit Dryer Vent (D) NoVent Fan Mechanical Permit lssuahce State Surcharge Total Permit MECHANICAL PERMIT Furnace Exhaust Hood By slgnature, I state and agree, that I have caref ully examined the completed application and do hereby certify that all lnformation hereon is true and correct, and I f urther certify 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 without permission of the Building Safety Division. I further certify that only contractors and employees who are ln compliance with ORS 70.l.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address ls readable from the street, that the permlt card ls located at the front of the property, and the approved set of plans will remain on the site at all times during construction. \./,/Slgnature t' /.i .,- I r, t,r.,/ -/ -Date MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electricat) (A, B, C, D, and E Combined) Lo 4 VALIDATION: RECEIPT NUMBER DATE PAID fa? AMOUNT RECEIVED BECEIVED BY ';:. ; : ' ':i,' :,.;i'',lI* 1 .j THE PROPOSED WORK tN THE - HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be slgned and approved by the Historlcal Coordinator prior to permit issuance. Received By: V,/k #= SP,il'NGF'ELO CITY OF SPFINGFIELD, ONEGON 225 TIFTE STRBEf, SPRII{GFIBLD, ORBGoN INSPBGIION REOTIESf,: OPPICE: 726-3759 1. II)CATrON Or I,BGAL DESCRIPTION o JOBtlt Permits are non-traflsferable and expire if vork is not started vithin 180 days of lssuance or lf vork is suspended for 180 days. 2. COIiTRACTOR INSTALI,ATTON ONLY Electrical Contractor Address ttZ t i Fo, 4o //o *I cl o Supervisor Llcense Number s 57 trs Expiration Date t0-t -?{ constr contr. Number ?3 7 5 3 Expi ration Date 9- e l-7 4 The follo'wlng proiect ae zubmlttcd-trr the tollowktg ii"i"ri, tiiiJ"oires not requlre specific land uee DESCRIPTION4 U!r*'-h QSc-;,'L BLBCTRICAL PERHIT APPLICATION City Job Nunber COHPIJTE PEB SCEEDTILE BBLOV A. Nev Residential-Single or Multi-FamiIy per dwelling unit. Service Included:Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Hanuf'd Home or Hodular Dwelling Servlce or Feeder $ 8s.00 s 1s.00 $ 40.00 B Services or Feeders Installation, Alterations c-or Relocation: Sum on affi E V-ac Phone OP 9?fos-53m 200 amps or less $ 50.00 201 amps to 400 amps - S 60.00 401 amps to 600 amps - 5100.00 601 amps to 1000 amps- $130.00 over 1000 amps/volts - $300.00 Temporary Services or Feeders Installation, Alteration or Relocati 200 amps or less $ 40.00 201 amps to 400 amps - $ 55.00 over 401 to 600 amps - $ 8o.oo Over 600 amps or 1000-6Tts see rrB* c. i si of Owners Name Electrician Orl Address 4oo il ef*A 3+ Ci ty qlc lJ Ot Phone-:7-- OSNER INSTALI.ATION The installation is being made on property I ovn vhich is not intended for sale, Iease or rent. 0,rners Signature: DATB: RBCEIVBD D. Branch Circuits Nev, Alteration or Extension Per Panel One Circui t \./ S 35. O0 3r"" Each AdditionalCircuit or vith Serviceor Feeder Permit _ $ 2.00 f B. l,tiscellaneous (Service/feeder not included) -Each installation Pump or irrigation _Sign/Out1ine Light ing- Limited EnergY/Res Limi ted Energy/Comm - $ s $ $ 40 40 00 00 00 00 oO 20 36 5 SUBTOTAL OP ABOVB 5f State Surcharge TOTAL Post and Beam - Prior to floor insulation or decking. Floor lnsulation - Prior to decking. Sanitary Sewer - Prior to filling trench. Storm Sewer - Prlor to filling trench. Water Line - Prlor to filling trench. Rough Plumbing - Prior to cover. lnsert - After flreplace aPProval and lnstallation of unit. Curbcul & Approach - After forms are erected but prlor to placement of concrete. Sldewalk & Driveway - After excavation ls complete, forms and sub-base materlal in place. [-l Fence - When completed. Street Trees - When all required trees are planted. lr blocklng is complete. Plumbing Connections - When home has been connected to water pnd sewer. a Electrical Connection - 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. E E E tl K E E P.L,HSE GAR ACC N S E ,sT HE PROPOSED WOBK lN TFE: -' ISTORICAL DISTRI CT, OR ON iHe HtsronlcAL REG ISTER?Lot {aces Lot sq. ftg. Lot coverage ToPograPhY Total height Lot TYPe - lnterior .- Corner =.- Panhandle .-- Cul-de-sac lf yes, this application must be signed .nJ-'.PPro,"O bY the Historical Coordinator prior to permit issuance' APPROVED E, PLAN CHECK PERMIT 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. Plans Reviewed By Date Receipt Nu BUILDING VALU AND BUILDING This permlt is granted Plan Check Fee: Date Paid Received By: BUILDING PERMIT .. VALUE (A) SO. FT. X $/SO. FT.ITEM Main Garage Carport Total Value Building Permit Fee State Surcharge Total Fee Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ADDITIONAL COMMENTS ITEM Flxtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home PLUMBING PERMIT No FEE FT. FT. FT. (c) Plumbing Permit State Surcharge Total Charge Wood Stove/ lnsert/ Flreplace Unit Dryer Vent MECHANICAL PERMIT (D) N0 Mechanical Permit lssuance state surcharge Total Permit Furnace Exhaust Hood Vent Fan By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all lnformation hereon ls 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 ln compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permlt card ls located at the front of the property, and the approved set of plans will remain on the site at all times during construction. Signatu Date MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excludlng electrical) (A, B, C, Q and E Combined) 15,'/,1 I ,J ED DATE PAID AMOUNT RECE RECEIVED BY VALIDATION: BECEIPT NUMBER Permit No: Address: lssued by Date: AsJ R OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4) , requires residential construction permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. This state- ment is required for residential building, electrical, mechanical, and plumbing permits. Licensed Architect and Engineer applicants, exempt from registration underORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in th icable blanks, and initial boxes 1 and 2, and either box 3A or 38: CONSTRUCTION CONTRACTORS BOARD 0244J Bt91 / 9-?,, Date WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT 1 2 I own, reside in, or will reside in the completed structure. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. A My general contractor is , Contractor registration number-. I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. 3.8 I will be my own lf I hire subcontractors, I will hire only subcontractors registered with the Construc- tion Contractors Board. lf I change my mind and do hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board and I will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and understand the lnlormation Notice to Property Owners about Construction Besponsibilities on the reverse side of this form. 3 OR 4,--,(/Z&-,n*, ffnatui'e ot lernyrt. App!y'an\---/ INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This lnfor-mation Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. lf you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibitities and areas of concern. EMPLOYER RESPONSIBILITIES: lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an "employer" and the people you hire will be "employees". As.the employer, you must comply with lhe following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Department of Flevenue at 378-3390. Unemployment lnsurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Division DHR a|378-3224. @rkery Qompensation lnsurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. lf you fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 373-7434. U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages. ymentevenifyoudidn'tactuallywithholdthetax.Formoreinformation,call the lnternal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONGERN: Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage lnsurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punc- tures, fire, or work that must be re-done. Time to Supervise Employees: Make sure you have sufficient time to supervise your employees Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. lf you have additional questions, write to:Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 024N 10124189 }tGFIELDFFSIr!trNTlAL PERMIT APPLICATION lnspections: 726'3769 Office: 726-3759 LOCATION OF PRO ASSESSORS MAP: LOT: - BLOCK: JOB NUMBER 225 Fifth Street Springfield, Oregon 97477 TAX LOT SUBDIVISION PHONE: ZIP: OTHER ADDRESS CITY:STATE: NDESCRIBE WOR ADDITION DEMOLISHNEW- REMODEL MECHANICAL: ELECTRICAL: PHONEEXPIRESADDRESSCONTRACTOR'S NAME GENERAL: PLUMBIN CONST. CONTRACTOR # # OF BDRMS - OFFICE USE J- LAND USE: ZONING CODE: FLOOD PLAIN WATER HEATER: * OF UNITS: RANGE: SECONDARY HEAT: SQUARE FOOTAGE: QUAD AREA: * OF BLDGST OCCY GROUP: * OF STORIES: CONSTR. TYPE: HEAT SOURCE: To request an inspeclon, you must call 726-3769. Thls ts a24 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. REQUIRED INSPECTIONS [-l remporary Electrlc Rough Mechanical - Prior to cover. al Plumbing - When all lumbing work is complete. Site lnspection - To be made after excavation, but Prior to setting forms. Rough Electrical - Prior to Final Electrical - When all electrical work is complete.cover. Underslab Plumbing/ Eleclrical / Mechanical - Prior to cover. Electrical Service - Must be approved to obtaln Permanent electrical power, Final Mechanical - When all mechanical work is complete. Footing - After trenches are excavated.l-l Flreplace - Prlor to faclnglJ materlals and framlng lnsP. Final Building - When all required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting.Framing - Prior to cover, Other Foundation - After forms are erected but Prlor to concrete placement. Wall/Celling lnsulation - Prior to cover. Underground Plumbing - Prior to filling trench.[l Drywall - Prior to taoing. MOBILE HOME INSPECTIONS Underlloor Plumbing/ Mechanical - Prior to lnsulation or decking,Wood Stove - After installatlon. Post and Beam - Prior to floor insulation or decking.lnsert - After firePlace approval and installation of unit. Blocking and Set.Up - When all blocking is complete. Floor lnsulation - Prior to decki ng.Curbcut & Approach - After forms are erected but Prior to placement of concrete. Plumbing Connections - When home has been connected to water pnd sewer. Sanilary Sewer - Prior to filling trench.Electrical Conneclion - When blocking, set-up, and Plumbing inspections have been approved and the home is connected to the service panel. Storm Sewer - Prior to filling trench. Sidewalk & DrlvewaY - After excavation ls comPlete, forms and sub-base material in Place. Water Line - Prior to filling trench. Fence - When comPleted. Rough Plumbing - Prior to cover. Street Trees - When all requlred trees are planted. Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed. OWNER: E tl E tl tl .S TH E PROPO$ED HISTOHICAL DISTR v'tonK '* 'K rI ICT, OR ONLot faces Lot sq. ftg. Lot coverage TopograPhY Total height Lot TyPe - lnterior - Corner - Panhandle - Cul'de-sac THE HISTOBICAL BEGISTER? --lf yes, this application must be signed and apProved bY the Historical Coordinator prior to permit issuance' APPROVED: GAR ACCP.L.HSE N S E BUILDTNG PERMIT .' VALUE (A) SQ. FT. X $/SO. FT.ITEM Main Garage Carport Total Value Building Permit Fee State Surcharge Total Fee BUILDING VALUE, PLAN CHECK AND BUTLDING 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 Springfleld, 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. Plans Reviewed By Date Plan Check Fee: Date Paid: Receipt Num Received By; SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. FEE (c) FT. FT. PLUMBING PERMIT FT. Plumbing Permit State Surcharge Total Charge N0 ADDITIONAL COMMENTS Wood Stove/ lnsert/ Fireplace Unit Dryer Vent (D) N0Vent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Furnace Exhaust Hood By signaturg 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 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 certlfy that only contractors and employees who are in compllance with ORS 701.055 will be used on this project. I further 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 of the property, and the approved set of plans will remain Date on the site at all times durl ng construction. Signatu MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excludlng electrical) (A, B, C, Q and E Combined) 15 75 cD DATE PAID VALIDATION: RECEIPT NUMBE AMOUNT REC RECEIVED BY ITEM Fixtu res Resldential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home CITY OF SPF OFEGO'V SPRII{GFIELO 1 225 FTFIE STREEf,l: l r'.l:iln ,i::i:: ?1,:ij:llli'X i':,:::".:,::rittf,RrcAl pERilrr AppI,rcArroN SPRTNGTIELD, OREGON 974?:l;'- "cl 4D bqvINSPECf,ION REQTIBST z 726-3769.L ,L City Job Nunber OFPICB: 726-3759 Dere 3la>lq 3. COHPI.ETB FEE SCffiDULB BBLOS LOCATTON tJcy, A I s:grrr,tuie 9tl .Irat. N.n ,t."*d"ntlaI-S I.AGAL DESCRTPTION tlulti-Family per Service Included: DESCRIPTION 1000 sq.ft. or Iess Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Hodular Dvelling Servlce or Feeder s Bs.oott^P $ 1s.00 $ 40.00 ingle or dvelling unit. Items Cost Sum Permits are non-trallsferable and expire if vork is not started within 180 days of issuance or if vork ls suspended for 180 days. 2. CO}ITRACTOR INSTALI^ATION ONLY Electrical Contractor Address \tto ADn Adl,( ovJ W ci Phone +r6 -241 Supervisor License Number iration Date I o-t-7q Constr Contr. Nunrber {t{ c '?) Exp iration Date of Supervlsing 'rclan Omers Name B c. 5. SUBTOTAL OP ABOVE 5f State Surcharge TOTAL Services or Feeders Installation, Alterations or Relocation: 201 amps to 400 amps _ 401 amps to 600 amps _ 601 amps to 1000 amps_ Over 1000 amps/vo1ts Reconnect Only 200 amps or less 201 amps to 400 amps -0ver 401 to 600 amps Over 600 amps or 1000-frTls Temporary Services or Feeders Insta1lation, Alteration or Relocarion L @' 40.00 55.00 80.00 ee rrBrr aSoE s s0.00 $ 60.00 $100.00 $r30.00 $300.00 $ 40.00 $ $ $ s $ 40.00 s 40.00 $ 20.00 $ 36.00 Exp r Address Clty Phone O9NBR INSTALI,ATTON The installation is belng made on property I ovn vhich is not intended for sale, lease or rent. Onners Signature: DATB: D. Branch Circuits Nev, Alteration or Bxtension Per Panel One Circuit $ 35.00 Each Additional Circuit or vith Service or Feeder Permit $ 2.00 B. Hiscellaneous (Service/feeder not included) -Each installation Pump or irrigation _Sign/OutIine Lighting_ Limited Energy/Res Limited Energy/Comm * RBCBIVED 6o OF 7it7: SPRI]{GFIELC) RESID ENTIAL PERMIT APPLICATION lnspections: 726'3769 O{(ice: 726'3759 Qft, JOB NUMBER q L,tn1q7 225 Fifth Street Springfield, Oregon 97477 400 N. 25th Street LOCATION OF PROPOSED WORK: ASSESSORS MAP:o3 e,t I'l SUBDIVISION: 747 -8249PHONE: 97 477zlPSTATE: J ORspringfield,CITY: ADDRESS: OWNER: 400 N. 25th Street NEW -- F1EM9DEL x ADDITION DEMOLISH OTHER oftf)cD DESCRTBE WoRK: Install gas furnace MECHANTCAT: comfort Ftow Heeti-ng-855-trrL-lst-Eugene374O2 #00460 6/27194 342-8101 PHONEEXPI RESADDRESS ELECTRICAL: CONTRACTOR'S NAME CONST. CONTRACTOR # CENERAL: PLUMBING RANGE: # OF BDRMS _ OFFICE USE _ LAND USE FLOOD PLAIN WATER HEATER: SECONDARY HEAT SOUARE FOOTAGE: OUAD AREA: , OF BLDGS ZONING CODE: OCCY GROUP: # OF STOBIES HEAT SOURCE: - CONSTR. TYPE: -=__'__-- Torequestaninspection,youmustcallT26-3T6g.Thisisa24hourrecording'Allinspectionsreques' made the Sali;e, working day, lnspectionS requested after 7:00 a.m. will be made the following work ted before 7:00 a.m. will be day. REOUIRED INSPECTIONS f-_l TemporarY Electric ll Rough Mechanical - Prior to cover. Final Plumbing - When all plumbing work 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. al Mechanical - When all Underslab Plumbing / Electrical / Mechanical - Prior to cover' Electrical Service - Must be approved to obtain Pe!'manent electrical Power. mechanical work is comPlete. Footing - After trenches are excavated.Fireplace - Prior to facing materials and f raming lnsP. Final Building - When all required insPections have been approved and building is completed. Masonry - Steel location, bond beams, grouting.Framing - Prior to cover' Foundation - After forms are erected but Prior to concrete placement. ftother Wall/Ceiling lnsulalion - Prior to cover. Underground Plumbing - Prior to filling trench.[_-l Drywall - Prior to taping MOBILE HOME INSPECTIONS Underlloor Plumbing / Mechanical - Prior to insulation or decking'[-l Wood Slove - After installation Post and Beam - Prior to floor insulation or decking.lnsert - Alter firePiace aPProval and installation of unit. Blocking and Set'UP - When all blocking is comPlete. Floor lnsulation - Prior to decki ng.Curbcut & APProach - After forms are erocted but Prior to placement of concrete. Plumbing Connections - When home has 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. Storm Sewer - Prior to filling trench. Water Line - Prior to fillinEt trench. [-l Fence - When comPrleted Slreet Trees - When all required trees are planted.Rough Plumbing - Prior tc cover.i-l 5 goc TAX LOt l /) -and air condi ti oni ng i nnfu:di ng ductwork' r fl E [-l Sidewalk & DrivewaY - AfterU excavation is comPlete, forms and sub-base material in Place. tl E E E E tl r tl Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed. Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac Se i bac ks HSE GARP.L.I ^i"I - THE PROPOSED WORK IN THE }1 ISTORICAL DISTRICT, OR ON THE HISTORICAL FIEGISTER? _-..- lf yes, this application must be signed and approved by the Historical Coordinator prior to permit isSuance. APPROVED N W E VALUE (A) X S/SO. 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 condrtion that the said construclion shall, in all respects, conform lo the Orclinance adopted by the City of Springfield, inctu<jing the Development Code, regulating the construction and use of buildings, and may be suspended or revol<ed at any time upon violation of any provisions of said ordinances. Plan Check Fee: __- Plans Reviewed By Date Date Perid Receipt Number: Received By: SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Developrnent Charge is due on all undeveloped properl.ies within the City limits which are being improved. ITEM Fixtu res Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE (c) FT. FT. F-r. PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge N0 ADDITIONAL COMMENTS Wood Stove/ lnsert/Fireplace Unit Dryer Vent fvri.r'r. (D) NoVent Fan _ts-cp_ -lSe-q __l_c-Qo__aa asl_s Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rn ace Exhaust Hood 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 f urther certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springf ield, 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 perrnissron 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 pro ject. I f urther agrce to ensure that all required inspections are requested at the proper time, that each address is readable f rorn the st!'eet, that the permit card is located of the property, and the approved set of plan LlDate t the front will remain ngon the site at al I times duri const ruction SiS"r,rX MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) es25 f,o 3l >E )q'Jas,AMOUNT RECEIVE-D DATE PAID RECEIVED BY rlR VALIDATION: RECEIPT NUMBER -- }