HomeMy WebLinkAboutPermit Plumbing 1991-08-21RESIDENTIAL
PERMIT APPLICATION,/------.\
I ns pecti ons:keO-gzos>
Office: 726-3759- -h,
JoB NUMBE ^ 7/oo g
225 Filth Street
Springfield, Oregon 97477
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LOCATION OF PROPOSED WORK:
ASSESSORS MAP:/7az3o-7 y TAX LOI o= /61
LOT BLOCK:SUBDIVISION
PHON E
ZIP:STATE:
D
CITY:
ADDRESS
OWNER:
NEW
-
REMODEL ADDITION DEMOLISH OTHER
DESCRIBE WORK:
MECHANICAL:
-
ELECTRICALi
-
EXPIRES PHONEADDRESSCONTRACTOR'S NAME
CONST.
CONTRACTOR #
GENERAL:
PLU M BI NG
RANGE:
# OF BDRMS
_ OFF]CE USE _
LAND USE:
ZONING CODE:
FLOOD PLAIN
WATER HEATER:
* OF UNITS:
SECONDARY HEAT
SOUARE FOOTAGE:
OUAD AREA:
* OF BLDGS:
OCCY GROUP:
* OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
To request an inspection, you must call 726-3769. This is a24 hour recording. AII 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
J---l Temporary Electricll
Rough Mechanical - Prior to
cover.
Final Plumbing - When all
plumbing 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/ Electrical /
Mechanical - Prior to cover.
Electrical Service - Must be
approved to obtain Permanent
electrical power.
Final Mechanical - When all
mechanical work is complete.
Footing - After trenches are
excavated.Fireplace - Prior to facing
materials and framing 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 prior to concrete
placement.
Wall/Ceiling lnsulation - Prior to
cover.
Underground Plumbing - Prior
to filling trench.l-l Drywall - Prior to taoing
MOBILE HOME INSPECTIONS
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.Wood Stove - After installation
Post and Beam - Prior to floor
insulation or decki ng.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 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.
Sidewalk & DrivewaY - After
excavation is comPlete, forms
and sub-base material in Place.
Water Line - Prior to filling
trench.l--l Fence - When comoleted.
Rough Plumbing - Prior to
cover.
Street Trees - When all required
trees are planted.
Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.
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Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot r-e
_ lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Setbacks
P.L.HSE GAR ACC
N
S
E
, E PROPOSED 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 $/so. Fr.
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
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.
iewed By Date
Receipt Numbe
Plan Check Fee
Date Paid:
Received By:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ITEM
Fixtu res
Flesidential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
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/f--{
1='* ^v
c--
(c)
N0
FT.
FT.
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Fireplace Unit
Dryer Vent
(D)
N0Vent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rnace
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 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
of the property, and the approved set of plans will remain
Date
on the site at all times during construction
/t-Signature
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, q D, and E Combined)
2r
-?1'7/DATE PAID
AMOUNT RECEIVED
RECEIVED BY
VALIDATION:
RECEIPT NUMBER
FT.
Permit No:7/z'qs:*-
Address A/8 ->zOZ
lssued
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Fill in the appticable bianks, and initial box 1 and either box 2A or 28:
Note: Oregon Law, ORS 701.055(4), requires residential building_permit applicants
*no "r. iot regi6tered witn tde'Cohstruction Contractors Board to sign. the
folowing statemeniOLiore the building permit can be issued. Licensed Architect
"no
engin."1. "ppiit"nii, "igrpt trori 'registration under oRS 701'010(7), need
not submit this staiemeht. Thi; statemeit will be filed with the permit'
Date: fr --sl=t'
1.[Yr
2. A.
OR
I own, reside in, or will reside in the completed structure'
My general contractor is
Contractor registration number
gnature Permit ppl cant Date
CONSTRUCTION E,oNTRACTORS BOARD
I will instruct my general contractgr that all subcontractors who work on
the structure must-be registered witnine Coniiruction Contractors Board'
I will be my own general contractor'
en'**.u$,15m{n*-t$-:ffrt',';1-rs$ilf,f,frfi
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r hereby certiry that the above inrormation is correct and that r have read and understand
the rnformation Notice to property ffi;;; "uour
conrtiu"iion nesponsibilities on the
ienetse side of this form'
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