HomeMy WebLinkAboutPermit Building 1992-05-19rAX t.or: -/1140
SPFlIN(;FIELI'
SUBDIVISION: --
1r+O ,oZffZl-
F]LOCK
36- /3--
R:SIDENI"IAL
PERMIT APPLICAIION
I t lt;1,,',';tiilti,,:,' ?6'3761)
OllicE; l2l) .,,'.'9
-:rou NUMB ,o - 7?o 7/a
225 Fifth Street
$iprlrlglitJl.l, Oregutt tJ7'l r'l
LOT:
LOCATION Ol- PFtOt'OSi::D WOflt(: -
ASSESSonS r,.,rAP: /2A S-
OWNER: -
ADDRESS:
CITY: ., -,--
PHON F,:
STATE:c_--z'P,-7-:2/22
ADnrr()N DLMoLtslI- orHER
-RdAk<
DP L- la.DESCRIAE V\.r\ )RK:
NEW -,-.-. REMC)D[:L .-
C:Oll ltlAOl( )1, Sl NAMI
(=r'/
cENt nnr > X Mc/e,,,,
t,Lt JMtllN(.. -
EXPTRIS
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trl lohJ IADDlll::iS
,//-r/??r*/b _l.tzsrl 2
CONST.
CONTRACTOF.I '
EL ECTRIC,'.I , -
MECtlANlt)/ii:
OUAD ARf /i
# oF BLD(.iSl
OCCY GR()tri':
# ol' sTollli ,
WAIEn l1t Al : R:
FLOOD PLAIN:
ZONING CODE: --=
# OF BDRMS:.-
SECONDARY I-IEAT: -
SQUARE FOOTAGE: -
- OFFICE USE _
r OF UNITS: -
RANGE:
CONtITR. TYPE:
HEAT SOURCI :
LAND USE:
Tc re.lucst ar inspectic)!), ycu rnust call 726-3769. Thts ls a:24 hortr recording. All inspectiorls requested before 7:00:r.m- trvill lre
made the ),ii1,(] wothip(l day, insl)ections rL.questecl after 7:00 a.m. will be made the following work day.
REOUIRED INSPECTIONS
l- I Tetrrli,t,.rry Ele,:tti,LI l- I nouSh Mcclranical - Prior to
'- -' (;()ver.
Site lrr:;lreclion - To be rlrade
aftt-'t r:.. irvilti()ll, Irtlt pli(,r to
sellan(i l,)t'lll:i.
Unclcr s l.rb Plrrrnl-:irrg/ Electrical /
Meclriirrrcal - ['t t, )I to (;{)vcr.
Foolirrgl - Afler tlenches are
€XC&vi-r lr'd.
Masonry - Stet:l locatiorr, botld
bearilS,,-lrOutitlg.
Found;rtion - A{ler fornls are
erecte(1 but Prior to concrete
placcnr,'nt.
Undetgrotrnd Plurrrbing - Prictr
to fillinl lrenclt.
Underlloor Pltrmhing/ Mechanical
- Prrc,r to insttlillion c>t rlccl<irtg
Posl :rrrrl Lteatrt - [)rioI to floor
insulatir)n or (le(;l rrlg.
Floor lrrstrlation
der:1. rrt1l
Prirrt ttr
Sanilirry Sewer -- Prior to f illittll
trc,nclr.
Storrn iie'wer '- l'rior to (illing
tren<: lr
Walcr I ine - f 'rir-rr to fillirrg
1rg11r;lt.
Fireplace -- Pttor to facing
materlals itrtcl lr;rming lrrsP.
Framing -- Prior to cover.
Wall/Ceilirrg lrrsulation - Prior to
cover.
Wood Slove - After installation
lnsert - Af ter fireplact: approval
anrl installation of unit.
Curbcut ti Approach - After
forrns aIe {rre(il(.jd but l)Ilor to
pli,rcemcrr I r.if concrete.
Final Plunrbirrg - Wltcrt all
pltrtrtllirti; wot li is c()trll)l(:to.
Final Meclranical _ Wlr,rn ;rll
rnech;lnicill worl( is t:i.rtrltletir
Final Building - Wlrcrr ;rll
requi red insptrction:; ltlrt'tl bt,t'tl
approved 3n11 bulldirlrl ir.
cornpleted.
Other
MOBILE HOME INSPECTIONS
)4;*:h Er'l'';tric;tr - Prior to
Fl::,|,,?;i$i:i',;.,Iililll,il:
\-/rt..rrical Service - Must be
,Jdaptrrove(i lr, obtain Pcrltlanent
electricell pow()r.
t:l Blocking an<l Sel-Up - Wltt rr rrll
l)locking is c()rnplL.lrl
I)lunrbing Cotrnectiotts - \//lr,,n
hotne has been conr'i,:i:lr-'d lii
water and sewer.
Electrical Connectiou -- Wltt:ri
Llor;l<ing, set-up, an<i l,lLrrrtbtr'r,;
insp{rctions lurve bcr-,rr a[)pr()vt(]
and tlte hotne is conrrt",r';tod l,
the servicc p:rnel.
Final - Af tet all requirc.l
inspections are apprc)vc(l an,.l
porches, skirtirrg, decl<s, and
venting lravc lieen inst,rlli-.d.
L_l
LI
5/ sia"*alk & Driveway - Af ter
,,lAl-qxr:avati(),, is (:,rtIrpiete, fot'trts
anrl sub-lr:i:;e trtaterlal in place.
l-l Fence - When coml)lcted
Streel Trccs - When all required
trer.s are;rlarrtecl.
Rough l)lumbing - Prior tr->
cover.
tl
tl
tl
D
t_l
i_l
tl
L]
E[J
[] OrVwall - Pri<-rr to taPin0.
S THE PROPOSED WORK IN ITiE
dISTOFIICAL DISTRICT, OR ON
THE H ISTOFIICAL REGISTER? ---___
lf yes, this application must be signed
and approved by the llistorical
Coordinator prior to permit issuance.
APPROVED:
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
PL.HSE
N
S
E
ACC
Sctbacks
GAR
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This perrnit is grarrted on the express con<jition that the sai(l
conslruction shall, in all respects, conform to the Ordinance
adoptecl by the City of Springfield, inclr-rding thc
Developrnent Cocic, regul:rting the construction :rnrj ttsc of
btrildirrg:;, ancl may be suspended or revoked ;rl ;rrry lirnc
upon violation of any provisions o( said ordinanccs.
Plan Check Fee: ------
Receipt Number: -
DatePlans Rcvir.,wed By
Date Paid
Received By
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carport
VALUE
(A)
X $/SQ. FT.
Total Value
Building Permit Fee
State Surcharge
Total Fee
Systerns Development Charge is due on all trndeveloped
properties within the City limits which are being inrproved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
ITEM
Fixtu res
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
lvlobiie l-loir:e
FEE
F
(c)
N0
FT.
FT.
FT,< 50' zS.*
/,'e
n,r ZC./-(e,
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Tolal Charge
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 lrave caref ully examined
the completed application and do hereby certify that all
information hereon is true and correct, and I f urther certif y
that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfielcl, and the Laws
of the Slate of Oregon pertaining to the wotk clcscribed
herein, ancJ that NO OCCUPANCY will be ntarJt: of any
structure without perrnission of the tsuilding Safety Division.
I f urther certify tlrat orrly contractors and enrployr:es who
are in compliance with ORS 701.055 will be trse(l on this
project.
I {urther agree to ensure that all required irlsllcctions;rre
requested at the proper titt're, that each address is re-'adable
from thc street, that the pcrmit card is locater-l al lhe front
ignatu
Date
of the propertY,and tlre approved sel of Plittr will retn;rin
othe site at all
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk -5* t
Curbcut
---
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
7t/o,
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Cotnbined)
ffi
37,oo
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED "
FIECEIVED BY
qs,7D
//ffiy
' ''. i ';..r'ri-ii,i i:rr.}iact as submitlod has the lollowing: ;,.. ; r,:l'rcl {loo9 nol require specific lgnd use Aie
SPTilNGFTEL1,
ELECTRICAL PERHIT APPLICATION225 FIFTB STREET
SPRINGFTELD, OREGON 97477
INSPECTI0N REQUESTz 726-3769
OFPICE: 726-3759
Permits are non-transferable and expireif vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. COMRACTOR INSTALI.ATION ONLY
Electrical Contractor
Address
JOB
4 orc,Lli d-f, e,'tratt ,ra
Phone %'Z.SZy'
Supervisor License Number Sszs s
Expiration Date
Constr Contr. Number /SaS '2
Expiration Date d\
Signature of Supervising Electrician
Ovners Name
City Job Number
\ffi COXPIJTE TEE SCHEDULE BELOS
A. Nev Residential-Single or
MuIti-FamiIy per dwelling unit.
Service fncluded:
Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
$ Bs.oo
$ 1s.00
$ 40.00
Services or Feeders
Installation, Alterations or
Relocat ion:
LDQ-
, ?=harqa
1 LOCATION OE INSTALI,ATION74o tJ, ?^/9 sT,
Sum
B
200 amps or less X,201 amps to 400 amps /
401 amps to 600 amps _
601 amps to 1000 amps_
0ver 1000 amps/vo1ts
Reconnect 0n1y
c Temporary Services or Feeders
Installation, Alteration or Relocation
D. Branch Circuits
Nev, Alteration or Extension Per Panel
One Circui t $ 3s.00
Each Additional
Circuit or vith Service
or Feeder Permi t L $
200 amps or less $ 40.00
201. amps to 400 amps _ $ 55.00
Over 401 to 600 amps _ $ 80.00
Over 600 amps or 1000 volts see rrBrr above
$ so.
$ 60.
$100.
$1 30.
$
$
$
s
00
00
00
00
00
00
<,/'t dO
2.oo 4!?
Address
Ci ty Phone
$300
40$
40
40
OITNER INSTALI.ATION
The installation is being made on
property I own vhich is not intended
for sale, lease or rent.
Owners Signature:
DATE:
RECEIPT
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/outline Light ing-
Limi ted Energy/Res
Limited Energy/Comm
20
36
.00
.00
.00
.00
5 SI,MTOTAL OP ABOVE
5Z State Surcharge
TOTAL
ONEGO'U
RECEIVED BY:
L
IJGAL DESCRIPTION\)OV4t- t> trtoct
ciry (€.- Z
x
SfPonrTo
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