HomeMy WebLinkAboutPermit Building 1992-11-08-.-F-\_-^
II\lGFIELO
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Otlice: 726-3759
LOCATION OF PRO ED WORK:9ov I
ASSESSORS MAP:
JOB NUMBE
225 Fif th Street
Springfield, Oregon 97477
TAX LOT:Lor BLOCK:SUBDIVISION
PHONE:
zlP
-\z
c/YSTATE:
f'7r) yz
CITY:
ADDRESS:
OWNER:
Ll
NEW REMODEL _
-r)DESCRIBE WORK:
ADDITION DEMOLISH OTHER
ADDRESS
EXPIRES PHONE
7.l)-r V
CONTRACTOR'S NAME
MECHANICAL:
ELECTRICAL:
CONSI
CONTFIACTOR #GENERAL:
PLUMBING
- OFFICE USE -
LAND USE:
WATER HEATER
* OF UNITS:
g OF BDBMS:
RANGE;
OUAD AREA:
A OF BLDGS:
SECONDABY HEAI
SQUARE FOOTAGE:
OCCY GROUP
# OF STOFIIES
FLOOD PLAIN:
ZONING CODECONSTR. TYPE
HEAT SOURCE:
To request an inspecilon ,vo u must calt 726-3769. Thlmade the same working day,; lnspections requested
s is a 24 hour recordin g. All lnspections requested before 7:OO a.mafter 7:00 a.m. will be made the followin will be
REQUIRED INSPECTI
g work day.
[-l Temporary Etectric ONS
Rough Mechanicat _Prior tocover.Final plumbi ng - When allSitelnspeclion - To be made
plumbing work is complete.
af ter excavatio n, but p rior to Rough Electrical _Prior tosetting forms.cover.Final Electricat
electrical work i - When allx H:$:,lij,,"r,t?i::11,::l':;,,, x s complete.
Electrical Service _Must be Final Mechanical _mechanical work isl--l Footing - After trenches are
-
excavated.
approved to obtain permanent When altelectrlcalpower.complete.
II:t],":r - prtor to factnsmaterlals and framlng lnspl
Framlng - prior to cover.
Wal!/Ceiting lnsulatton _ prior tocover.
Drywall - prlor to taping.
Build ing - When allItlTnw - Steet tocauon, bondDeams, grouting.
f"o1-1!3tion - After forms are
:l99tud but prior to concreteplacement.
,TffiIfl;"iild PJumbins - Prior
required i nspections have beenapprovedand bui lding iscompleted.
Other
3B?,,:','."J,",'Jff"r,,,:r",y,T*[,,ff
:
,r_"-:,, r.TO Beam _ prtor to ftoorrnsulation or decking.
Floor lnsutatlon _ prior todecking.
Wood Stove _ After lnstaltation.
:?T ;k,illiJ,',;?,,j;i,: a p p rovq,
,C1rU-cut & Approach _ Afterform-s are erected but prior topracement of concrete.
MOBILE HOME INSPECTIONS
;:lHl sewer _ Prior ro fiilins
P-1"tT sewer - Prror to fiilingtrench.
Y:t:l Ltne _ prtor to fimnstrench.
l-gyotr Plumbtng - prior tocover.
8,*L',lS,T3"i'J;Hg.- when a,,
lly1bi"n Connecrrons _ Whenn.ome has been connected toWater and Sewer.
Sidewalk & Drtveway _ Afterexcavation is compiete, formsand sub-base materiat in ptacl.
Fence - When completed.
flSi[i.":""'#:u*:#H:.
flt^d _the.home is connected torne service panel.
fl Street rrees - when ail required.- trees are planted.
,F-i!:l : After ail required
ffr?#;:Mg:{ii[,#
E
fl I r
Lot faces
Lot sq. ftg.
Lot coverage
TopograPhY
Total height
Lot Typ
'4 \J
-
lnterior
-
Corner
-
Panhandle
-
Cul'de-sac
Setbacks
P.L.HSE GAR ACC
N
S
E
I HE PBOPOSED WORK IN THE
HISTORICAL DISTRICT, OR O
THE H ISTORICAL REGISTER?
lf yes, this application must be signed
and aPProved bY the Historlcal
Coordinator prior to permit issuance'
APPROVED:
Date
Plans By
BeceiPt Numbe
B
A
, PLAN CHECK
ERMIT
UILDING VALUE
ND BUILDING P
ress condition that the saidrmit is granted on the exPThis pe conform to the Ordinancection shall, in all resPects'constru including thethe CitY of SPringfield'adoPted bY tion and use ofregulati ng the construcDeveloPment Code'd at any timebe susPended or revokebuildings, and maY
ions of said ordinances'
Recei \q
upon violation of
Plan Check Fee:
Date Paid:
BUILDING PERMIT
VALUE
(A)
SO. FT. X $/SQ. FT.ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee ondevel pedualeduonISmenChargeDevelptemsSySmbeproved.aich re ngtswhCimtinhethityESpropertiSYSTEMS DEVELOPMENT
(B)
CHARGE (sDC)
ADDITIONAL COMMENTS
ITEM
Fixtures
Residential Bath(s)
SanitarY Sewer
Water
Storm Sewer
Mobile Home
PLUMBING PERMIT FEE
No
FT.
FT.
(c)
Plumbing Permit
State Surcharge
Total Charge
Wood Stove/ lnsert / Fireplace Unit
Dryer Vent
MECHANICAL PERMIT
(D)
No
Furnace
Exhaust Hood
Vent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
By signature, I state and agree' that I have carefully examined
the completed application ana do hereby certify that all
lnformation hereon is true and correct' and I (urther certi{y
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
StructurewithoutpermissionoftheBuildingsafetyDivision'
I further certily that only contractors and employees who
are in compliance with ORS 701'055 will be used on this
proiect.
sure that all required inspections are
er time, that each address is readable
Signature
Date
(../
o{
I further agree to en
requested at the ProP
mit card ls located at the front
rom the street, that the Per
set of Plans will remainthe proPertY, and the aPProved
on.on the site at all times duriggMISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
tl
Curbcut
-
ll
Demolition
State Surcharge
(E)Total M iscellaneous Permits 5
\
AMOUNT RECEIV
FIECEIVEO BY
DATE PAID
VALIDATION:
RECEIPT NUM
TOTAL AMOUNT
(A, B, C' D, and E
DUE (excluding electrical)
Combined)
FT.