HomeMy WebLinkAboutPermit Mechanical 1991-04-01ELE,
RESID ENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
LOCATION OF PROPOS
ASSESSORS MAP;
LOT
afr,
JOB NUMBER
225 Fifth Street
Spri ngfield, Oregon 97 477
TAX LOT
tnRK:
BLOCK:SUBDIVISION
OWNER:
ADDRESS:
CITY:
PHONE:
STATE ZIP
ERDEMOLISH
DESCRIBE WORK:
NEW
-
REMODEL ADDITION
I 3 1 C
ELECTRICAL:
ADDRESS EXPIRES PHONECONTRACTOR'S NAME
MECHANICAL
CONST.
CONTRACTOR #
GENERAL:
PLUMBING
_ OFFICE USE _
.9B,AJLd
I
ul
g OF BDRMS:
RANGE:WATER HEATER
QUAD AREA:
* OF BLDGS:
FLOOD PLAIN:
ZONING CODE
SECONDARY HEAT
SQUARE FOOTAGE:
OCCY GROUP:
* OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
LAND USE:
# OF UNITS
To reguest an inspection, you must call 726-3769. This is a24hour 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
Temporary Electric Rough Mechanical - Prior to
cover.[--l Finat PlumbingtJ plumbing work - When all
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.
Foundalion - After forms are
erected but prior to concrete
placement.
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Wall/Ceiling lnsulation - Prior to
cover,
Underground Plumbing - Prior
to filling trench.l-_-l Drywall - Prior to taping
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.
MOBILE HOME INSPECTIONS
Wood Stove - After installation.
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 toplacement of concrete.
Plumbing Connections - When
home has been connected to
water and sewer.
Sanitary Sewer - Prior to filling
trench.
Storm Sewer - Prior to filling
trench.
Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
Electrical Connection - Whenblocking, set-up, and plumbing
inspections have been approved
and the home is connected tothe service panel.
Water Line - Prior to filling
trench.
Fence - When completed
Street Trees - When all required
trees are planted.
Final - After all required
inspections are approved andporches, skirting, decks, andventing have been installed.
Rough Plumbing - Prior to
cover.
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Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type \-/
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Setbacks
P.L.HSE GAR ACC
N
S
E
. - IHE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR O
THE HISTORICAL REGISTER?
lf yes, this application must be si
and approved by the H
Coord inator p permit
APPROVED
BUILDING VALUE, PLAN{ CI4ECT<
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.
Receipt Number:-
DatePlans Fleviewed By
Plan Check Fee:
Date Paid
Received By
VALUE
(A)
X $/SQ. FT.
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carport
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
Fixtu res
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
(c)
N0
FT,
FT.
FT
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
Wood Stove/ lnsert/ Fireplace Unit
Dryer Vent
(D)
NoVent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rnace
Exhaust Hood By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that all
information hereon is true and correct, and I further 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 permission of the Building Safety Division'
I f urther certify that only contractors and employees who
are in compliance with ORS 701.055 will be used on this
proiect.
I {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
X"
t
Signat
Date
on the site at all ti uring constru
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-.-
ft
Curbcut
--
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
VALIDATION
RECEIPT NUMB
DATE PAID
AMOUNT RECEIV
RECEIVED BY
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
A
Permit No:
Address:Lp*n
lssued
OR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUGTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
following statement before the building permit can be issued. Licensed Architect
and Engineer applicants, exempt from registration under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 28:
e.
1
2. A.
OR
! own, reside in, or will res
My general contractor is
ide in the completed structure.
I Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
B. t-l I will be my own general contractor.
lf I hire subcontractors. I will hire only subcontractors reqistered with the
Construction Contractors Board. lf I chanoe my mind and -do hire a oeneral
contractor. I will contract with a contrattor -who is reqistered w'ith the
Constructibn Contractors Board and ! will immediately-notify the office
issuing this building permit of the name of the contradtor.
I hereby certify that the above information is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side ol this form.
--y **./ -- c1
CONSTRUCTION CONTRACTORS BOARD
0244J',190
Date
COPY TO ISSUING AGENCY PERMIT FILE
PY TO APPLICANT
@s
I
.L \Date:
Signature of Permit Applicant '
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