HomeMy WebLinkAboutPermit Plumbing 1996-04-26RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Offlce: 726-3759
LOCATION OF PROPOSED WORK:
SP
?7 /t{/JOB NUMBER
225 Fifth Street
Sprlngfleld, Oregon 97477
ASSESSORS MAP:bzo, I L
LOT BLOCK:
TAX LOT O€ro
SUBDIVISION
Qar
PHONE:
ZIP:c7reSTATE:CITY:
ADDRESS:
OWNER:
NEW- REMODEL ADDITION DEMOLISH OTHER
DESCRIBE WORK:
ELECTRICAL:
PHONE
?ff, z8:o z
ADDRESSCONTBACTOB'S NAME
GENERAL:
MECHANICAL:
CONST.
CONTRACTOR #
I
EXPIBES .1
A-, Gptoof, ^an 7'7 e f uJ t I #
--jffit8Eerrfiilffi---
lJ N I rs:
- ---ToMMENoED oR I S88Al$6tQffi ror
rY PE:
--aNfi8oDAY
PERldd? F B D R MS:
HEAT
OUAD
CONSTR
WATER
ulres, YUtrI iaw req LAND USE:
OAF
#oF SOURCE:SECONDARY HEAT:
-HEATER:BANGE:SOUARF- FOOTAGE:,--
- oFFtcE usttloTlGE:
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspectlons requested before 7:00 a.m. wlll be
made the same worklng day, lnspections reguested after 7:00 a.m. wlll be made the followlng work day.
REQUIRED INSPECTIONS
Temporary Eleclrlc Rough Mechanlcal - Prlor to
cover.
Flnal Plunrbing - When all
plumblng worl( ls complete.
E
tl
E
tr
fl
Slte lnspectlon - To be made
after excavatlon, but prior to
settlng forms.
Underslab Plumblng/ Electrlcal /
Mochanlcat - Prlor to cover.
Footlng - After trenches are
excavated.
Masonry - Steel locatlon, bond
beams, groutlng.
Foundatlon - After forms are
erected but prlor to concrete
placomont.
Underground Plumblng - Prior
to fllllng trench.
Underlloor Plumblng I Mechanlcal
- Prlor to lnsulatlon or decklng.
Post and Beam - Prlor to floor
lnsulatlon or decklng,
Floor lnsulation - Prlor to
decklng.
Sanltary Sewer - Prlor to fllllng
trench.
Storm Sewer - Prlor to fllllng
trcnch.
wrtcr Llnr - Prlor to fllllng
trench.
Rough Plumbing - Prlor to
cover.
Rough Electrical - Prior to
cover,
Electrlcal Servlce - Must be
approved to obtaln permanent
electrlcal power.
Flreplace - Prlor to faclng
materlals and framlng lnsp.
Framlng - Prlor to cover.
wallrCblllng lnsutatlon - Prlor
cover.
l--l Drywall - Prlor to taplng.
Wood Stovo - Alter lnstallatlon.
lnserl - After flreplace approvql
and lnstallatlon of unlt.
Flnal Electrlcal - When all
electrlcal work is complete.
al Mechanical - When all
lcal work is complete.
Flnal Buildlng - When all
required lnspectlons have been
approved and building is
completed.
Curbcut & AJrproach - After
forms are erected but prior to
placoment of concreto.
Sidewalk & Drlveway - After
excavatlon ls complete, forms
and aub.bago matsrlal ln placo.
tl Flnol - When cornpletod,
Street Trees - When all requlred
trees ar€ planted.
Other
MOBILE HOME INSPECTIONS
Blocking and Set.Up - When all
blocklng ls complete.
Plumbing Connections - When
home has been connected to
water and sewer.
Electrlcal Connection - When
blocklng, set-up, and plumbing
lnspectlons have been approved
and thq homs ls connectod to
the servlce panel.
Final - After all required
lnspectlons are approved and
porchos, sklrtlng, clecks, and
ventlng have been lnstalled,
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PLUI,IBING:
tl
E
E
E
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lfr
BUILDING
AND BUIL
l) .,?l
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Type
-
lnterlor
-
Corner
-
Panhandle \
-
Cul-de-sac
i .s rxe pnoPosEo woRK rN THE.' HrsToBtcAL DtgTBlcr, oR oN, THE HISTORICAL REGISTER?
lf yes, thls appllcatlon must be slgned
and approved by the H lstorlcal
Coordlnator prlor to permlt lsguance,
APPROVED:
E,
PE
LAN CHECK
DING RMIT
Thle pernrlt ls granled on tho oxpreg! condltlon that the rald
construction shall, in all respects, conform to the Ordlnance
adopted by the City of Sprlngfleld, lncludlng the
Development Code, regulatlng the oonltructlon and uee ofbulldlngr, and may be suspendeid or revokod at any tlmc
upon vlolation of any provislons of sald ordlnances.
Plan Check Fee:
Date Paid
Receipt Number:-
Received By
Plans Reviewed By Date
Systems Development Charge ls due on all undeveloped
properties wlthln the City llmlts which are being lmproved.
ADDITIONAL COMMENTS
By slgnature, I state and agree, that I have caref ully examlned
the completed applicatlon and do hereby certlfy that all
lnformatlon hereon ls true and correct, and I f urther cerilfy
that any and all work performed shall be done in accorrlance
wlth the Ordinances of the Clty of Sprlngfield, and the Laws
of the State of Oregon pertalnlng to the work descrlbed
hereln, and that NO OCCUPANCY wlll be made of any
structure wlthout perrnission of the Bulldlng Safety Divislon.
I further certify that only contractors and employees who
are In compllance with ORS 701.055 wlll be used on thls
proiect.
I further agree to ensure that all requlred lnspections are
requested at the proper tlme, that each address ls readable
lrom the street, that the permlt card ls located at the front
of the property, and the approved set of plans wlll remaln
on the slte at all times durlng c
Slgnature
P.L.HSE GAR ACC'
N
S
E
BUTLDING PERMIT
VALUE
(A)
ITEM
Maln
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
SO. FT. X $/SQ. FT.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ITEM
Fixtures
Residentlal Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
FEE
(c)
PLUMBING PERMIT
Plumblng Permlt
State Surcharoe
Total Charge
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolltlon
State Surcharge
Total Mlscellaneous Permits (E)
tfoo
t/-00
/.f7
ZL,5A
MECHANICAL PERMIT
/Flreplace Unit
(D)
Fu rnace
Exhaust Hood
Vent Fan
Wood Stove/ln
Dryer Vent
Mechanical Permit
lssuance
State Surcharge
Total Permlt
TOTAL AMOUNT DUE (exctudtng etectricat)
(A, B, C, Q and E Comblned)
f
I btslVAI-IDATION
BECEIPT NUMBER
DATE PAID
AMOUNT BECEIVED
BECEIVED AY
Date /(
FT.
N',-_-
FT.
FT.
SPRINGFIELC,
BACKFLO1I PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING .SATEf,Y. DIVI SION
225 FITTH STREET
SPRINGFIELD OB 97477
OITFICE:
INSPECTION LINE:
726-3759
726-3769
ADDRESS:
CITY:
?
BACKFLOLT pERHIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADI{IN. rEE) - $16.20
JOB LOCATION:
?
ASSESSORS MAp *r /4A<+-,,a 'tAx LoT *z O2ls./
OIJNER:
PHONE *:)?,; i
STATE:ztYz2/)B
CONTRACTOR:t
ADDRESS: PHONE *3
CITY: STATE:ZlPz
CONSTRUCf,ION CONTRA TORS REGISTRATION *:EXPIRES:
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
bECTTUOV PREVENTION DEVICE HAS BBEN INSTALLED AND IS VISIBLE FOR INSPECTION
iTio-lzogl. r ALSo srATB THAT ALL TNFORMATToN oN THrS PERHTT/APPLrCATroN rs
CORRECT.
e &.*.7/-L-
rOR OFFICE USB
?ao
JOB {I:
RECEIPT ll: 2 /2 ISSUED BY:
DATE OF APPLICATI ONI, - // ^Z q -AZ
TOTAL AI,IOUNT COLLECTED:-=e
:
C'TY
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