HomeMy WebLinkAboutPermit Building 1989-11-01Job Loeaticn:
gZ
Tcs Lot llAssessors lulaP #
Subdirsision (/6 6-
A)ne/,:ffi Phone:
zip
Address:
City
Descr"Lbe Ltot'l<:
N e,n
Date of APP Licaticn
L
tdditicn
Reee".#
..RESIDT'ITIAL..
APPLICATLb{/PERt4ru
225 NoY'th |th Stt'eet
SprLn4field, Oregon 97477
Building Di-uision
7 26-37 53
SPRINGFIELD
Date
Lont ril S
General
l'l urnb i.ng
I.lechau I
ectr ca
L',1ll tlElet't. t'Srrpe fv1€ln
DEI.IOLI'IIO!! OR BU
Sanitat'y saser eapped at property Lir:e
Septtc tcnk ptoryed artd filled trith gra:tel
Final - lfiien aboue itms ate ecmpleted
and uhen Cenolttion is eomplete or strLi3-
ture nooeC and prewLses cleaneC up'
Llob Le Hcmes
Blocking and' Set-uP
Pltnbing connections '- aa)e? ad uater
Electrieal Ccnnect'ton - Bloeking' eet-ut -
"ii oU^AAo connecti-ons mist be appna;ad
before neqiesting eleclrical inspeetio::
Aecessor'; BuilCitg
Final - After pcrckes, skinting, decks,
etc. ate eonPleted.
Pege 1 of !
It ia the reaPoncibi.tle penni t holdet' to see that aLL inspections ale naile at the psoper tine, that eaeh addregs is readab..e
Lity of of the proPentYat all times.J'ron the street'
apptoted p
that the oermtt
Llan shc
card ia Located at th,e fnontan^4*suilding Nuisiott nwaber, job aCCress' tYPe of inspec)iaiLL remain on the Buildintt !it;
P!?IIEDUPE FoR INSPECTt1!t .EIQUE|T:CALL 7
iequested and ahen ljou tiLL be readu Jor
:..iil be nade the sane dcg' "equests mcde
Stft tUSPtC':tOUt '!o be
'eocaoaticn, but Pr[ot' tc
m
fonns.
UNDERSLAB PLUMBINC, EL,ECTRI=CA!' &
l4ECHAllfCAk To be nade before anY
ffit876',teted.
POOTINL & FOUNDATICN: To be truCe
after trenches al'e ercaDated dn'd'
7or." *n erected, but Ptior to
pouring ccncrete.
UNDERCROUTTD PLUI'\? INC., SSW-IP. w!.Til'
bnlJttAct: To be mude Prlov Lo JLL-
Tfi-l?enches.
l-l upomrrcon prutntt,t 4 tttc:!-4tttc,at'
^| | io be nade p?ior Lo LnstaLLatlon oJ
flooz' insulation or decking'
tr
POS\ AND BEAM: To be made Prion to
TiiiiTTffl6{of floor insulation or
decking.
GtlTthese inspecl tots haoe beet;
nade and appz'ouet!.
il:?EPLACE: Prior Lo Plceir"g faeing
mat;Afi; and before fratning inalec-
tion.
FRAI.IINC: !'tust be requested afber
6iffit of rough plur,bing, electri-
ctl & mechanical. ALL noofing
btacing & chitrmeYs, ete. tntst be
conpleied. No ucrk is to be con-
o"il"d until this insPection lne
'been made anC approxed.
26-3769 (r'ecorder) state your City
inspection,Contractcrs cr Asners numbet,. Requestg receit;ed befcre 7:00 ctCeslgrated job
rcne, and phone
after' 7:00 on uiLL bc ntade the nctt doy
Your City Desigrtzted Job NunbeY
made after
set up of be naCe
required uapoTt
but before anu
il':R
aft x-l'u Lflau
l,oll 'ION
To ba'riers are in place
Lath, gypsun bacird ot'
s applied, and before1x7couel,L n(l
tttu Lnsu La
LL
tion concea Led
r-Dt DRYIIALL INSPEL"TI1N: Tc be natle
I Al At*;nA""tfts in Ptace'u brt pnior bo cnY taPing'
MASONRI: Steel Location, bond
iiffilgrouting or oerttcals in
aceordaltce ttth U.B.C. Section
2415 ,
!gg!E!7'lL: After installation is
ccrnpleted.
IENCE: Hher: r:onPlete -- ProuiCe
jit"i or noualtle sectians thnough
DIID
aLL proiet:t cond.it.i.ons, such cts the i.nstal-Lattctn of st|eet t11e-2-,- co,',Pletion-of the
t,equired land.sccping,-Lt"., ^r"t be satislied befo,e the BUILDINC FINAL canbe requested'
itINAL BUILDINC: Ttte Final Building Inspection mtst be requested after the Ftnal Plunbtng
Electrical, aru! I,leclnrieal rnspec*ons hquo been nade artd appt'oued'
CURB & APPRCACH APP.)N: Aftex' forns
ate erecLeC lut Pyiot' bo Poutang
concrete.
|IDFWALK & DRII!El't!,y: For aLL con-
cii6-p"o WEt li.i s tt'ect right-
of-t*:u'. to be maCe after aL!' exea-
tltin"q'conplete & fot-:t t; t'k & cub-
base "rwteiirt?. in Place.
FIIIAL PLUMBITIG
PINAL MECIIAilTCAT,
FINAL ELECTRICAL
*At,r, l.t,1NIlCf,E:; AN!) CL\ANOUT:: lfi[-f fi/,: lC()L-:;:.:fBLf, AD,IUST\IEN? T0 BII I|ADE A? ll0 CCST f0 CI?y
m
u
@
JOB NO.
Lot Sq. Etg.
% of Lot Coueraga_
i of Stor"tes
Total Height
?opography
soLAR AqcEss REQ.-,^L-CO G+
BeCi'consCr.
LOT TYPE
_ Intericn
_ Connet
_ Panharulle
CuL*de-sac
Lot Faces -
;-' Lt t?1.2d
Reeeipt fl:
/2.24t-52
-
I HAVE CAREFULLy EXAMINED the completed application {or pennit, and da
hereby carti-fy that aLL infornati.on hereon is true anl correct,, and. f
further eet:ti{y that any ard aLL uotk perforrned ahall be done i.n aceor-
dance urtth the Ordinances of the City of Springfield, and the Laas of the
State of )regon pertainino to the work Cescrtbed herein, cnd tLnt NO OCCU-
PANCY uilt be nnde of any structure uithout permission of the Building Di--uision. I furtlier certify- that o:tLy contractot s at;d cnplcyeel dho dre 1:n
canpliance oil;h ORS 701.055 t,till be used on this ptoject
Zone:
Energ!1 Sourees Tyoe
!le-at
P. t,Ilousr,:Caraqe Acee:is Water lledte|
L;as t Fi
{;oulh tloodctoue
I,/est
r?pM SQ. FTG x Val-ue
tLtain ,4pp /7/4sns
c<ttaae 1-?Z /f./2 ?rvtb
CarportaffiZa
,,1ceessot,1t ?66 /2,/a ?v5.*
TOTAL VALUE
"162A2
Plan
S.D.C. 1.5 x
Date Paid.r=
Building Vqlue & Permit
Thi.s permit i.:; eranl:ed on the ccpress condition tlnt the said construetionslxtll., in a_11. respects, <::onfcnn to the Ordirwilce adopte,i 6:y the City ofSpt'ittgfieLd, i.naktding the Zoning Crdinance, regulcLttq thb ccnstrubticn
and.use of builclinlTs, ancl me11 be suspended or reuokei at oty time u1,on utc-
LaLiott of atty pt,cuisions of s<id 1ndinances.
Eui.Ldtng Permit.
Total Clnrgea
State
Plumbing Permit
No pereon slnll constnrct, instal!, all;er or ehanu3e dnA neu cr eristing
p_Lwnbing or drainage sllsl;en in alnle or in part, unless aueh person is the
Legal posseasor of a ualid plwnber's License, eecept that a pe?son may do
plunbing aork to property ahtch is owed, Leased or operated by the appli-
cant,
Sigtled
NO FEE CHARCE
Seuer
*
d7
I?EM
Residential (1 bath)
li*tures
Plwnbing Pennit
State
Electricol Permit
Were State Laut requines tlzat the electrtcal uork be done by an Eleotrieal
Contractor, the eleetrical portion of this permit shall not be ualtC untilthe Label has been si.gned by the Electrical Contractor.
L Pemit
NO
Neu/Estend. Citcuits
Sertlice
State
?otal
CIIARCEITXMNCFEE Mechqnicql Permit
Wcodstooe
Vent Fan
khanst llood,
D
Permtt f;sucnce
Mechanicel Permit
-- ENCROACHMENT --
Secari,tu Depo4t
Storage
Maintenance
Pcrmit
C-ut'bcu
Sida,talk
Fence
Electrieal label
blobile Ucnte
E zgz, g6TOTAL AMOAN? DUE:*
Ir t
?otal
t
*
. Iotal Clwraes
SfaXa
..RESIDENTIAL..
APPLTCA. _,N/PERMrr
225 Nov'th Sth Str'eet
Spr.tngf'Leld, )regon 97477
Buildtng Dtuision
/ao-o/oo
SPFIINGFIELD-
-zoJob Locaticn:
?c,s Lot; llAssessora Map #
(artno* rt(rryLa6;Subditision:
Oumer
Phone:Address:
City
Describe h'onk:
;; bou-o A NL\r/ (.u) aw*af,r@rl wtl
tbaa a* A r{uw pskaa-u oF Arl??RoY,
l.b ,.oLF& @ *tc'rA- $OcNoF(,
Va1,ue Dv€?Date of App LLcatLCN
tdditicn
RemoCeL
A
PtSe 1 of J
G
Date
Ceneral
Plwnbing
trical
i.leclwricaL
Construetion Lender
rt ia the responsibilita of the pennit ho_L<let' to see that aLL inspec-tions ave nade at the propel' time' that ecch cddress is teadab"e
fron- the- stre'et, anC thht the_pe?mtt_eayd is Loeated at .!h_e. frant of the--pro.perty
'r's";di"S"ri;;;:ir;;pp";t;erl plbn slu:Ll tenain on the Buildtn.a Site at aLL ttmes.
pt?ocEDUpE EoR rNSpECrroN.gletlESr:CALL 726-3769(t,ecord.et,) state your city desigrated job nz,unber' iob aCitess' type of inspec:icti
requested and. uhen i,or nady fo1 inspection, Contractcv,s "", A,mers"r,cre Lnd phone nunber'. P.equests receited befcre 7:C0 r'
---iLL be made the sane dcy, tequests-ni:.de afiet'?:00 on uiLL be nnCe the nerl: torkirq day'
Iour City Desigr'ated Job Nwnber Is:
Required sr:e.cticns
SITE INSPEC:ION: ?O bE natie after I Dgtt)Llrrall 0R
To be aLL insu
required uapor batriers at'e in place Sanilary seuer eapped tt pt'operty Lire
but befcre any Lath,gApsurn boarC or
Lied, and before Septic tank putped and filled uith graieltnLL couering is app
any insulation 4s concea Led
I]ARRIER BUILDI;ICS
erc"urtlo",nit pt'ior tc set uP of
fonne.
X
UNDERSLAB PLL'MBING, ELECTRTC,IL 8
MECH{-LIICAL: To be made before anY
i6it7{iZuered.
F)OTINC & FOUilDATICN: To be rnaCe
afi e r -tifrti{ a" eis c au at e C and
forns are et'ected, but prior to
pow,ing ccncrete.
uNpIRCPOUt',p PLUM?TNC4 SshyP' tr.4TE1'
DnAlttaCt: f" ne maCe Prior to fil-
Ifi-tren"hn".
lfl uaoffirrcon :tu$r:tc ,g utc.q.4ntc,t:,lt/' I T;b;-nadc pribr to tnstallabion of
floor insulction or decking.
f-7 posr AND BEAM: To be nadc prior to
l/ I TGt;TTaLi-cn of floor insuLalion or
decking.
I,IECH-
DRYWALL INSPECTI)N: Tc be made
;fter alT6w;n is in place,
but prior to cnu taPirE.
MASONI?Y: Steel T.ocatLon, bond
6ifrilgroutingl or uerttcals in
accordance ,nlth U,B,C. Section
WOODSTOVE:
;cnpT;tA.
After, .Jns l:allation is
Final - l{hen abcue itens ote ccnpleted.
and ahen CencLition is conplete or stttie-
tuye nooeC anC prenises cleaneC up.
Hcnes
Blocking ord Set-uP
Pkmbing eonnectians -- sarer anl uatet
Electrical Conneetion - Bloeking" set-ut
and olwnbinq connections rntst be appz'ctei-
beforc requesting e7.eclrical inspeeliot
Accessor'g Building
ANICAL: No aoYk
ffitL these inspe
tc
c*-ions haue been
CURB e APPRCACI"I APXON: After forTns
are eiicteC but pt'ior t:o Pcuring
concrete.
SIDII^\ALK 8 DRIltEllAI: Fov aLL con-
.""tei"ufi-;ltQ; s tre et right-
of-dcA, to be maCe after aLL erca-
Datina conplete & forn aork & sub'
base mcterial in Place-
Final - After pcrckes, skirting, decks'
ete. ave cotnpleted.
nade and approued.
PIPEPLACE: Priot' to Plceirq faeing
mcteriaLs and before franing inspee-
tion.
FRA\III\C: I,tust be requested af ler
ffiouat of rough plu,rbing, clectni-
cal 8 neclnnical. AL! roofirq
braeing 6 chimnegs, etc. tt"tst be
eompleted. lto ucrk is to be con-
cealed until this insPeetion has
been made anC approxed.
FII,IAL PLU!4BII|G
FINAL ME'HANICAT,
FINAL ELECTRICAL
IENCE: tr4ten conplate -- Pt'otttCejfiii or mooable sectians through
Dtto
{ZZGZ ft=c
ALL pyojecb condttions, suc!.:. as l;he'!.nstallation of glleet tnees, conpletion-of the
requ'ired. Landscaping, Ltu,, m.rst be satisfied before the BUILDINC FMAL can be requested'
'?INAL BUITDINC: ?he ltinal Building fnspectiot't rmtst be requested cfter the FinaL Plwnbing-rin.7";;"r;;'iC
Mechanical rnspect-ions hq'sc been made anl' appt'ooed'
I
x
\
E
*ALL !!|,!lllalE:: Atr[.) cl,t|Attl(-tTS !'lttsT Bn Accr;iirpt,t;, AD,TUST!tnilT ?o Bti l','4DE !? llo c:)sr T0 cI':Y
x
a
w
fa-LAR ACCESS REQ--L-CO G*
Bedroons:
Iat Sq, Ftg r/&-e LCT TYPE Lot Faces -
% cf Lct Couerage_
# of Stortes 2'
-
g-Intericr
Corner
Panhandle
CuL-de-sac
!teat
P. L.ilouse Access
Total leight
Topography -?'€-Qa th
t'/est
D^^^
ITE14 X Value Building Vqlue & Permit
This permit is granted on the erpr'ess cond.ttion that the satti.constvuction
sLnLL, in all respects, conform to the Crdinance adopteJ fiiy the Citg of
Springfield, including l;he Zoning Crdinance, r'egulctirtll the ccnstracticn
and use of buildtngs, and mey be su,spended or reuckeC at cny tl-ne upon oic-
Lation of any prcuisions of said 1rdinances,
TOTAL VALUE
S. D. C,*
Duilding Petwtt
State '?e-b Date Paid a
t#
?otal Chnrgea Signed:
f 1 f,lul N0.CHARGE PlumbinE Permit
No person shall construct, insl;alL, alter or clwn.qe Gn!1 neD cr eeisting
plu.nbing or drainage systen in uhole on in part, unless such person is the
Legal posseasor of a ualid plwnberts License, e&cept tkat a person nay do
plwnbing uork to property ahich is oumed, Leased or operated by the appli-
cant,
ResidentiaL bath)*
Sani Seuer 4r,
4?
Plwnbinq Pernit
7 *
FEE Electricol Permit
Nas/Er,tend Cincuits Were State Lau requires tl",a.t the electrical aork be done by an ELecfu,ical
Contractor, the electrical porl:ion of this permtt shall not be ualiC until
the Label has been signed by the Electrical Contractor,IatpcrarlJ Semice ^>
F
t
Total s,15
IT!M trct CIIARCE
E>E Mechqnicql Permit
Echrrust HooC
Vent Fan -6
Wcodstotte
a?
Pet:nrLt fssuance
l.lechanical Perrtt z:;5>
B
26-*
-- ENCROACEMENT --
>ealr1L L
f HAVE CAREFULLy nXAj'IfNED the completed application for permit, and da
hereby eertify that aLL infonnation hereon is true and correct, cnd. f
furtker certify that any ard aLL uork perforned slnll be done in accor'-
dance uith the Ordinances of the City of Springfield, and the Las of the* State of oregon pertaining to the uork Cescribed here'tn, cnd tVnt No )CCU-
P/.NCy uill be nade of any structure aithout permission of the Building Di-uision. f further certifs- thet only contractors and anplcyees uho are in
conpliance dith CRS 701.05S aiLL be used on this project
?otaL
Cutbcut
Sida,talk
b
Mobile llone
/6s-2a fo t
TorAL AMouNr D(rE:* 7LO\ 1V*=.+A
t
2-l r0t
JOB NO.f
_5
!
..RESID=NTIAL..
APPLICAI\AN /PERMIT
SPHINGFIELD
225 North Sth StY'eet
Spri,ngfield, Otegon 97477
Building Diuision
7 26-37 53
General
Plumbin
a
PRoctDUPE FoR INSPECTIOT'\ -BIa.Y.E1T;CALL 7
tequested and ahen ,ou DLLL be ?eadY lor
uiit be nade the e&e dcy, requests made
see that aLL inapectiona @e nade at the ptopet tine, that eaoh addrees is real'acie
Located at the frcnt of the Wa?e"tl
on the Building Sitc at aLL tines.
26-3769 (recot'der) state yottt City desigra ted job ntmber',iob aC&ess, tAPe
Pequests tecei"^ed
of inspeelicn
inspection,Contractars or A,mers nasne cnd plnne nuttber'.befcre 7:00 an
afte.r 7:00 on urill be nade the nert :,nrking dag
Iwr Cifu Desigr,ated Job Nwnbet' Is:.
Job Locaticn:
a2
?cs Lot #
Aesessors MaP #oa
Subdirtision:
Asnet,:
Phone:.L
Addz,ess:
F(=V VV77z,r 2'/'7 '
DescrLbe h'ot'k:
Date of VaLue
L
Additicn
tri-caF
SirD El-ec tt:c ian
UNDERSLAB PLUMBINC, ELECTRICAL &
wcn{:ncll: To be made before anY
ffitE-iotseted.
PO1TING & FOUNDATICN: Io be naCe
;F;A;a* s ar e-escatsat ed anl
forns a.r. erected, but Prior to
pou"'ing ecncreta.
UNI9RGPOU!]D PLUMErNG? SlrtEP. w,4L!-.1'
DRAIIIAGE: To be made Prlor to J1,L-
T@-6enchee.
attDERFLoOR PLUI.EING 4 MEC1A!IC-!'L: -i;n;ffi wloi- to-nstalLation o f
floon insulation or decking.
POST AND BEA\4: To be made Pt'Lot' to
ffiiiTffiT* o7 floor iraulation ot'
d.eckirtg.
ffiiTthese inspections haue beer
nad.e and approtseC.
!!!E!L498: PrLor to Placirq faeing
mcterials and before franing inspee-
tion.
FR!.ll!]lt: l,lust be requested aften
fiinoGt of rough plturbing, electri-
cal & neclnnical. ALL roofing
bracing A chinmeys, ete. rrust be
cotrpleted. Ilo ucrk is to be con-
. cealed untiL thi.s inspeeti-on lns
'been mad.e anC approt'ed.
SIT7 INSPECTION: TO bE ;
es"ffio";Tut pr"ior tc
fortns
FIilAL PLUMSIilC
FTNAL I.TECAANTCAL
FINA0 ELECTRICAL
INSULATION /VAPOR BARRIE R I!15!:C!]9N :
T;-be ^"de aft""AIL insulaticn avtd
required oapor botiers @e in Place
bui belore oty Lath' glpsurn b,catC or
taLL cotteri.ng- is applied, and. before
atg ittsulatinn is concealed,
DRYWALL INSPECTTON: TC bE NAdE
aft"r an@n"tTls in plaee,
but prior to cng taPing.
I4ASONRI: Steel Location, bond
dZffijgrouting or oe"ti,cals i.n
accordor.ce L)ith U.B,C. Section
2415.
V)2DSTO'/E: After instalTntion is
atnpLeted.
CURB & APPRCACH A!!9!1: Aftet fonns
d,e er."cr;A-frV;lo" to pouring
eonc?ete.
SIDWALK & DRfIWAI: For all con-
.";te pao@Gm; street tight-
of-teA, to be maCe after aLL etca-
oating corplete & for'n uork & eub-
base rruterLal in pLace.
IENCE: hthen conplete -- ProoiCe
gA;; or norsable sections through
P.U.E.
DEI,ELTTIO!1 OR BU ILDI
Sanitary seuer eapped at propett'g Line
Septic totk p"rped ant filled trith 7'a:sel
Pinal - h4ten abctse itens are ecnpleted
and uhen Cqtalltton is conplete o" st!'Lic-
ture moted cnd ptatri.ses cleaneC up.
Hcmes
rmde after
se+- up of
I
w
ALL project cond'i.tions, such as the installation of street trees, conpletion of tne
required Landsccpirgt etc., mtst be satisfied before the BUILDINC FMAL can be nequeexed.
FINAL BUILDING:
Electrieal, and
The Einal Building Inepection mtst be teqttested after the Final Plunbirq
Mechanical fnspections hauo been nade and approoed,
Blocking ord Set-uP
Plunbing connecti,ona -- aar)e! otd uater
Electrieal Cc,rmection - Bloclang' set-uc
and. plutnbing conneetions m;.st be apprct;eC
before requesting eleclrLcal inspeeliot:
Acceasovi BuiLCiry
pcrckes, alirting, decks,
1 ^L^)
Firnl - After
etc. are comp
Page 1 of 2
tr
il *AT,L MANHCLES AND CLEANOUTS IIUST BE ACCqSSIBLE, ADJUST:.E\II TO BE I,'!ADE AT IIO CCST IO CIIY
Date:
tr
JOB NO
Iat Sq. Ftg.
% of Lot Couetage
# of Stortes
?otal Height
?opogruphy
soLAR ACCESS REQ._
Grc
LOT ?WE
_ fntetior
_ Co"ne?
_ Panhandle
_ Cvl-de-sac
L-co c
BeCroonsLot Faces -
Lace
tou'e
DT House
North
RanEastFit,South
Ilest
I
Sq, F?C x Value I
I'bin
-@aqe
Ca.rpott
Accessoru
?O?AL VALUE
S.D.C. 7.5 c
Date Paid:
t#:
rhis perrntt is a?anted on th-e eop"ess cond.ition ttu, the said.-eonstyuetionsltalZ, in all rZspeets, eonform to the Criirwn.e ad.opted 6;y the City ofY\iy-f i
" L! : 1:c-,:udnns' th" 2;;;;";- ;;i ;;;;, t e sul at ins t he c cn s t tac ti c n@ta. use of buildirns. otd rlay t..r"upn"aii ot, t,euokeC at c./ry tine upon uic_Lation of ota pn"ui"ion" of Zaid a*.r*i"""'.
,t
Building pezlrrit
?otal Clntgea
State
Building Vqlue & permir
Signed:
FEE CHARGE
Fi^ztutes Plumbing perrnit
No pez,son stall const-ntet, inetal!., alter oz, e?nnge -any nea c? exlstingplwnbing or drainaae saste"n in uhoie oz,- in- patt, unless such person is theLegal posees"oo oy" o ulua pi" t":";i lt.."t;n, e&-cept that a pelson nay do
ffilns work to property ,hi.h i" ,,*"e:'i"ased o:n op.notJd..Ii"in" dppli_
Residenti,al (1 bath)
Seuet
Plunbtng perwit
State
Electricol Permit
Neu/Eatend. Citcttits 2>-Were Stdte Lan reoili,es th,at the eleetrieal uoz,k be d.one bu an Eleetnicalcont?actor, the etectrteal portion-oi;L;;';";;:;;t-;i";";,oZ",.tZua unt;.zthe Label hae been signed ry tne tteZtiiit' cont?actor.4*-
fa
L
NC F4F CIIARCE
Mechqnicol Permit
bhanet IIooC
Vent Fot
Ilcodstooe
Permit fssuotee
Mechanicel Permit
4
-- ENCROACHMEN? --
Sec,u-itA Deposit
Stotdge
Maintmanee
Permtt
Clpbeut
Sida,talk
Fenee
Electrical Inbq!
Mobtle Hame
.:? *
?otaL
! HAry CAREFULLy ZXA|LLNED the compLeted application for permit, and. dohereby eertif_y that aLL inforrnation het eoi ie true "i .Z"iiiii *,a rfut'tket' .certify that any ard aLL uork performed srall be done in aceo?-dance '-rith the otdinanebs of the city of bpring|ieid, and. the i,a;s of thestate of )regon pertaining to the wtk ceserib-od hnnZir, cnd tlat No occa-PLVcy uill b^e 1ryde of ang structut,e uithout pennission b7 tlr. sillal.ng Da-Dision. I funther certify that only eontraetors and anplcgees aho ar-e ineonpliance Dith ORS z01.0ss uiLL be used on thie projec't
TOTAL AI4OI.)il? DTJE:*
Signed Date
Cd.r'aqe Access.
SPFI]{GFIELD
OREGO'VC'TY OF
225 Fifth Street
Springf i e'ld , 0reg on 97 477
Off i ce:
INSPECTION LINE:
726-3759
726-37 69
Job Location:()
Assessors MaP #:Tax Lot #: /\f,ln OO
0wner:
Address:Phone #:d7q b Tszz
City:State:c/Zi p zf
Backflow Permit'is $15.00 + $0.75 State Surcharge
Contractor:IY-UV
Address:
-
Phone #:-
City:State:Li p:
Construct'ion Contractors Registrat'ion #:Ex pires:
3/sl
By s1gning th'is permit/appf ication, I agrgg to cal I for an 'inspection once the
bickfiow [revention device has been installed and is visible forinspection
(726-3769). I also state that all information on th'is application/permit is
correct.
e
!-/1- Fa
Si gna ur Date
l-
FOR OFFICE USE
Total Amount Collected:/s,7{/lrl-l-l A/^/-/-
71DJob #:Date of Application:
Receipt #:/'705L Issued By:
BACKFLOW PREVENTION DEVICE PERIJIIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
)
CITY OF SPR"VGFIELD, OREGO'V
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
{n
SPFI'ITGFIELD
Offi ce:
INSPECTION LINE:
7 26-37 59
7 26-37 69
Address: H 14 N L+7rt)
225 Fifth Street
Springfield, Oregon 97 477
Job Locati on ,31
Assessors Map #:0>- I Tax Lot #:
Phone #: -)uL-3L)Z
State:C)Q Zi p: Qlq18
Fence Perm'it is $5.00
tl@ Phone *:1\5-O?OS
State, OQ Zi p z V1'Q).
0wner:
City:
City:
Value of Fence ' g 09
Contractor/ I ns ta I I er :
Address. A-) a<,
Construction Contractors Registrat'ion #: )14 tf) txpires:) l>\ t,, o
By signing. this permit/appliSq!i9!r-l agree-to call for an 'inspection once myfence has been constructed (726-3769). I also state that all'information on-this application/permit is correct and that i was provided with the Springfield
Development Code requ'irements for fence standards.
1lz+loognareoaFI /
FOR OFFICE USE
Date of Appf ication:Job #, QQ q /,s.^
Rece'ipt #: \t ?OA Issued syt Q&
Total Amount Collected: 45.rf
4
Checked for Delinquencies:
c)
Checked for H'istorical Status, Y
(1//h