HomeMy WebLinkAboutPermit Mechanical 1992-11-04RESIDENTIAL
PERMIT APPLICATION
lnspections: 726'3769
Office: 726'3759
LOCATION OF PRO
ASSESSORS MAP:
o
SPtlINGFIELf)
L
nq ,)
JOB NUMBER
225 Flfth Street
Sprl ngf leld, Qregon 97 477
TAX LOT
SUBDIVISION:
k-.-)q/L- I/lfPHONE:0 t/c
ZIP:it
fu,?"tf
STATE:
OWNER
ADDRESS:
CITY:
tl LDEMOLISH OTHER
DESCRIBE WORK
NEW
---
REMODEL AODITION
PHONEEXPIRESADDRESS
*
CONTRACTOR'S NAME
MECHANICAL
ELECTRICAL:
CONST.
CONTRACTOR #
GENERAL:
PLUMBING
I OF BDRMS:
- OFFICE USE -
ZONING CODE:
FLOOD PLAIN:
WATER HEATER
* OF UNITS:
RANGE:
SECONDARY HEAT:
SQUARE FOOTAGE:
QUAD AREA:
r OF BLDGS:
LAND USE:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspecilon, you must call 726-3769. Thls ls a24hour recordlng. All lnspectlons requested before
made the same worklng day, lnspections requested after 7:00 a.m' wlll be made the followlng work day'
7:00 a.m. wlll be
REQU!RED INSPECTIONS
ff remnorarY Eleclrlc Rough Mechanlcal - Prlor to
cover.
Flnal Plumblng - When all
plumblng work ls complete.
Site lnspectlon - To be made
af ter excavatlon, but Prior to
setting forms.
Rough Electrlcal - Prlor to FInal Electrlcal - When all
electrlcal work ls comPlete.cover
Underslab Plumbing/ Electrlcal /
Mechanlcal - Prlor to cover.
Mechanlcal - When all
Eleclrlcal Servlce - Must be
approved to obtaln Permanent
electrlcal Power.
echanlcal work ls comPlete.
Footlng - After trenches are
excavated.
Flnal Bulldlng - When all
[--l Flreplace - Prlor to faclngu materlals and framlng lnsp.
requlred lnspectlon
approved and bulldi
completed,
s have been
ing ls.
Masonry - Steel locatlon, bond
beams, groutlng.Framlng - Prlor to cover.CCer
Foundatlon - After forms are
erected but Prlor to concrete
placement.
Wall/Celllng lnsulallon - Prlor to
cover
Underground Plumblng - Prior
to fllling trench.[-l Drywall - Prlor to taplng
MOBILE HOME INSPECTIONS
Underlloor Plumblng / Mechanlcal
- Prlor to lnsulatlon or decklng.Wood Stove - After lnstallatlon
Post and Beam - Prlor to floor
lnsulatlon or decklng.lnserl - After flrePlace aPProval
and lnstallatlon of unlt.
Blocklng and Set.UP - When all
blocklng ls complete.
Floor lnsulatlon - Prlor lo
decklng.Curbcut & ApProach - After
forms are erected but Prlor to
placement of concrete.
Plumblng Connectlons - When
home has been connected to
water and sewer.
Sanitary Sewer - Prior to f illinO
trench.Electrlcal Connectlon - When
blocklng, set.up, and plumblng
lnspectlgns have been aPProved
and the home le connected to
the servlce panel.
Storm Sewer - Prlor to filllng
trench.
Sldewalk & DrlvewaY - After
excavatlon ls comPlete, forms
and sub-base materlal ln Place.
Water Llne - Prlor to fllllng
trench.
nough Plumblng - Prlor to Street Trees - When all
trees are planted.cover.
oR
OCCY GROUP:
r OF STORIES:
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and
GABPL.
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isq
W
E
S THE PBOPOSED WOBK IN THE
-HISTORICAT DISTRICT, OR ON
THE HISTORICAL REGISTER? '-
lf yes, thls appllcatlon must be signed
ancj approved by the Hlstorlcal
Coordinator prior to permit issuance.
APPROVED:
Lot
Lot coverage
Topography
Total height
-
Cul-de-sac
BUTLDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
constructlon shall, in all respects, conform to the Ordinance
adopted by the City of Sprlngfleld, including the
Development Code, regulatlng the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions ol said ordinances'
Beceipt Number:-
DatePlans Reviewed By
Date Paid
Flecelved By:
VALUE
a
(A)
BUILDING PERMIT
Tolal Value
Building Permit Fee
State Surcharge
Total Fee
SQ. FT. X $/SO. FT.ITEM
Main
Garage
Carport
Systems Developrnrerrt Cltarge is due on all undeveloped
propertles wlthln the City limlts which are being improved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
(c)
FT,
FT.
FT.
PLUMBING PERMIT
No
Plumbing Permit
State Surcharge
Total Charge
Wood Stove/ lnsert/ Flreplace Unlt
Dryer Vent
lsza
/0 oo
.?{
(D)2r1.7{
N0Vent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permlt
MECHANICAL PERMIT
Fu rnace
Exhaust Hood By slgnature, I state and agree, that I have caref ully examined
the completed application and do hereby certify that all
lnformation hereon ls true and correct, and I further certify
that any and all work perforrned shall be done in accordance
wlth the Ordlnances of the City of Springfield, and the Laws
of the State of Oregon pertainlng to the work described
hereln, and that No OCCUPANCY wlll be made of any
structure without permission of the Building Safety Division.
I further certify tl.rat only contractors and employees who
are ln compliance witl'I ORS 701.055 wlll be used on this
project.
I further agree to ensure that all requlred inspections are
requested at the proper time, that each address is readable
from the street, that the permlt card ls located at the front
of the property, and th() approv€d set of plans wlll renrain
on the site at all tintes durlng construction.
-(
RECEIVE BY
Date
VALIDATIO
DATE PAID,
AMOUNT R
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut -- ft
Demolition
State Surcharge
Total Mlscellaneous Permlts (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Comblned)
ebls
ACC
S
Plan Check Fee:
)
Slgnature
RECEIPT NUMBER
INGFTELE)
t)t-oo
BLOCK
/J^)ItS
\103 )b L+')-,
q A))
LOT:SUBDIVISION:
TAX LOT:
LOCATION OF PROPOSED WOFIK:
ASSF.SSOBS MAP:
JOB NUMBER
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726'3769
Off ice: 726-3759
225 Flfth Street
Sprlngfleld, Oregon 97 477
PHONE:
fl*77Da.ZIP:STATE:CITY:
ADDRESS:
OWNER:
NEW -__-- REMODEL ADDITION DEMOLISH OTHER
DESCRIBE WORK:
EXPIRES PHONEADDRESS
'7cr
q)-ro
dJ
CONTRACTOR'S NAME
CONST.
CONTRACTOR #
GENERAL:
PLUMBING
RANGE:
- OFFICE USE _
ZONING CODE:
FLOOD PLAIN:
WATER HEATER
OF UNITS:
SECONDARY HEAT:
SOUARE FOOTAGE:
QUAD AREA:
r OF BLDGS:
LAND USE:
OCCY GFIOUP:
I OF STOBIES:
CONSTR. TYPE:
HEAT SOURCE:
To request an inspection, you must call 726.3769. Thls ls a 24 hour recordlng, Ail lnspeotlons requested before 7:00 a.m. wlll be
made the same worklng day, inspectlons requested after 7:00 a.m. wlll be made the followlng work day'
REOUIRED INSPECTIONS
[---l remnorary Electrlc Rough Mechanlcal - Prlor to
cover.
g
Site lnspectlon - To be made
a(ter excavation, but Prior to
settin0 forms.
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.
Foollng - After trenches are
excavated.
Masonry - Steel location, bond
beams, grouting.
Foundation - After forms are
erected but Prior to concrete
placement.
Underground Plumbing - Prior
to fllllng trench.
Underlloor Plumblng/ Mechanlcal
- Prior to lnsulatlon or decking.
Posl and BBam - Prlor to floor
insulatlon or decklng.
Floor lnsulallon - Prlor to
tlecking.
Sanilary Sewer - Prlor to filling
trench.
Storm Sewer - Prior to fllling
trench,
Water Llne - Prlor to fllllng
trench.
Rough Plumbing - Prior to
Rough Electrical - Prior to
cover.
Flnal Plumbing - When all
plumblng worl< is complete.
Flnal Electrlcal - When all
electrlcal work is comPlete,
Final Mechanical - When all
mechanical work is comPlete.
Flnal Buildlng - When all
requlred lnspectlons have been
approved and building is
completed.
Other
MOBILE HOME INSPECTIONS
Blocklng and Set.UP - When all
blocklng ls complete.
Plumblng Connecllons - When
home has been connected to
water and sewer,
Electrical Service - Must be
approved to obtain Permanent
electrlcal power.
[-l Fireplace - Prior to facinglJ materlals and framlng lnsP.
Framlng - Prior to cover,
Wall/Celling lnsulallon - Prlor to
cover.
l--l Drywall - Prlor to taplng
Wood Stove - After lnstallation.
lnsert - After flrePlace aPProval
and lnstallatlon of unlt.
Curbcul & APProach - After
forms are erected but Prior to
placement of concrete.
Sidewalk & DrlvewaY - After
excavatlon ls comPlete, forms
and sub-base materlal ln Place'
I---l Fence - When comPleted.II
Street Trees - When
Electrlcal Connection - When
blocklng, set-up, and Plumblng
lnspectlons have been aPProved
and the home ls connected to
servlc
V cover. 1 Urll-,trees are Planted venti ng been lnstalled.
q)l tql
# OF BDFIMST
-
TJ tl
E
n
tl
tl
tl
nr
tl
tl
Flnal
Lot faces
Lot sq. ftg,
Lot coverage
TopographY
Total height
Lot Type
-- lnterior
-- Cdrner
-.-- Panhandle
-.
Cul-de-sac
tbac
P.L.HSE GAFI ACC
N
S
E
THE PROPOSED WORK IN THE
-TIISTORICAL DISTRICT, OB ON
THE HISTORICAL REGISTER?
--lf ycs, this appllcation must be signed
and apProvec.l bY the H lstorlcal
Coortlinator prlor to permit issuance'
APPROVED
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is grantecl on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of Spring{ield, including the
Development Cocle, regtrlating the construction and use of
buildings, and may be susperrcled or revoked at any tirne
upon violation of alry provisions of said ordinances'
Plan Check Fee: --*-,.._
Fteceipt Nutnber:,.
Plans Rcvir:wecl BY Date
Date Paid
Recelved BY:
BUILDING PERMIT
VALUE
(A)
SQ. FT. X $/SQ. FT.ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
Systems Developrttlent Charge is due on all undeveloped
properties within the City limlts which are being lmproved'SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
ITEM
Fixtu res
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
1n N\
'15-g)
(c)
3 30
- l\J-P9^^
N0
FT.
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
Wood Stove/ lnsert/ Flreplace Unlt
Dryer Vent
MECHANICAL PERMIT
(D)
N0
Mechanical Permit
lssuance
State Surcharge
Total Permlt
Furnace
Exhaust Hood
Vent Fan
By signature, I state and agree, that I have caref ully examined
the completecl application and clo hereby certify that all
information hereotr is lrue and correct, and I f urther certify
that any and all work performed shall be done in accordance
wlth the Ordinanccs of tl're City of Sprlngf ield, and the Laws
of the Statc of Oregon pertalnlng to the worl< described
herein, an<j tirat NO OCCUPANCY will be made of any
structure without pcrmission of the Building Safety Division.
I further certify that only contractors and enrployees who
are in compliance with ORS 701.055 will be used on this
project.
I further 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 ls located at lhe front
of the property, and the approved set of plans will remain
on the site at all titnes durlng constructi
0sl <lqa
reSignatu
Date
MTSCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
--
ft
Curbcut
--.
ft
Demolition
State Surcharge
Total Miscellaneous Permlts (E)
VALIDATION:
RECEIPT NUMBr:n
DATE PAID.--%-7=o
- fiA
tL
AMOUNT NECEIVI,I.)
RECEIVED BY
:lI=la2-
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
*12-sa
)
ru__
FT.
Tq)FD-15
SPRIIiGFIEL} FIRE DEPAAT}IE}iT
FIRE DA,'4PGE REPOP,T
OR
EL TCTP,I CAL IlAZAP,O
NATtr.tlztlqz
TO:
FROI1:
SUBJECT:
Building Department
Springfield Fire DePartment,
Structural Damage to Building
Address or locat'ion of bui'lding II\ltt, 1l h
Name of o\',ner N,l.nt.'<11 O t't
Type of building Z
Estir,rated val ue of buiidinE
Est'imated loss to building
, {o. ;l J cll ia
F€, l,Jare use, etc. )
>ta
s
iing, S
2t , Dco
Date of fire tr'l zt lqz
Locat'ion of damage in building "AA;fto v,l mal<.(
(Rcof, I^Ial I , Exterior, Interior, etc.
Structural weakness as a result of the fire
(C
(ned rafters, Beams,Joi s ts , etc. )
Additjonal pertinent jnformation
El ectrical Hazard t^,1 a t
I Q,
(l,liring, 0utlets, etc. )
cc:-14
Sjqned ,/rq
SPllINGFIELD eaffiq_
tsLOCK:
&LOCATION OF PROPO E,D
n
AeJ
St;rlrrrl f lr:ltt, OI()qorl !)/'4 / /
LOT:
TAX LOT:
SUBDIVISION
ASSESSOBS MAP:
RESIDENTIAL
PERMIT APPLICATION
lnspections:726-3769
Office: 726-3759
JOL} NUMBEFI
225 Fifth Street
TJFION E:
STATE:LL G
ZIP: --l
-trtz__OWNER:
ADDRESS:
CITY:
\L
DEMOLtSt-l __oTHEn
DESCFIIBE WOFIK
NE.W
-
REMODEL ADDITION
EXPIRES PHOl.lEADDBESq
-_ 5t{l
rt 3
'S NA E.dfru s_72%12b-
lre 3113'7Yt7I-)2S?_-
I]LUMBING
G EN EFIA
CONT
MECHANICAL
ELECTRICAL:
CONST.
CONTRACIOR '
SE-
tt\\
HEAT SOURCE:
-.- --RANGE:
_ OFFICE
CONSTR. TYPE
SOUARE FOOTACE:
QUAD
ZONING CODE:
FLOOD PLAIN
WATEFI HEATER
# OF BLDGS
LAND USE:
# OF UNITS
, OF BDRMS: -. .-
SECONDARY IIEAT: -- -
D-__
OCCY GROUP:
'c OF STORIES
To request an inspection, you must call 726-3769. This is a 24 hour recordirrg. All inspections requested before 7:00 a.m. will be
made the same working day, inspections requested after 7:00 a.m. will be ma<Je the {ollowing work day.
REOUIRED INSPECTIONS
fl Temporary Electrictt Rough Mechanical - Prior tt)
cover.
| --l Firral Plurnbirrg - Wlrcn all| - I plrrrrrhing wot'k is cotrtlllete.
Site lnspection - Jb be tnade
af ter excavation, but Prior to
setting forms.
Rouglr Eleclrical - I)tit:t ttr tJ Final Electrical - When all
electrical work is r;otttplete.cover.
Underslab Plumbirrg / Electrical /
Meehanical - Prior to cover.
Electrical Service - Must be
approved to obtain Perrnanent
electrical power.
L_l Final Mechanical - Wlren all
meclranical work is complete.
Footing - Af ter tlenches are
excavated.Fireplace - Prior to facit-t91
materials and {ratning lnsP.
ffiinal Building - Wlren all
)() required inspections have beetr
approved ancl building is
corrr pleted.Masonry - Steel location, bond
bearns, grouting.
Wraming - Prior to covcr.
@yaillgeiling lnsulation - Prior to
? cover.
Other
-,.Foundation - After forms are
erected but prior to concrete
placement.
Underground Plumbing - Prior
to filling trench.d orywall - Prior to tapingr MOBTLE HOME INSPE TIONS
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.Wood Slove - AIter instr]llation
Post and Beam - Prior lo floor
insulation or decking.lnsert - After f irePlace aPProval
and installation of unit.
Blocking and Set.Up - When all
blocking is cornplete.
Floor lnsulation - Prior to
decking.Curbcul & Approach - Af tcr
forms are erected bllt llrior lo
placemerrt of concrete.
t_l Plumbing Connections - Wtten
home has been connected to
water and sewer.
Sanitary Sewer - Prior to f illing
trench.tl Eleclrical Corrnoctiott - Wtrctr
blockir-rg, set-up, and plutnbing
inspections have been approved
anrl tlro lrorne is <;onnectr:ti to
the sr:rvi<;e lratrel.
Storm Sewer - Prior to filling
trench.
Sidewalk & DrivewaY - Aftel
excavation is colltplete, fornts
and sub-base nlatr:rial itr Jrla<;c.
Water Llne - Prior to filling
trench.
Fence - Wlten comPlt:tr-'tl
Street Trees - Wlren all terltlire:rl
trees are planted.
Final - Alter all required
irrspections are approved attd
porr;hes, skirting, clecks, and
verrting ltavr: bee'tr installed.Rough Plumbing - Prior to
cover.
L_l
I
vN_
r
tf
L]
r
tl
Lot faces
Lot sq. ftg.
Lot cover:ioc
lbpograPhY
Total lreight
L ot lylrc
;,,11-1ior
(lot tttr
[);rtrlt.rl rr Ilrr
Otll'(l(::lit(l
Setbacks
FISE GnnPL. I
IS I PROPOSED WORK IN THE
HIST]'RICAL DISTRICT, OR ON
TI]E HISTORICAL REGISTER?
-__
..
It yes, this applicatlon must be signed
ancl apProved bY the Historical
Coor(linator f)rior to pcrmit issuancc.
APPI]OVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This perrnit is granted on the express conclitlon that the said
construction shall, irl 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:---
Plans Fleviewed BY Date
Plan Checl< Fee:
Date Paid
Received BY
BUILDING PERMIT
VALTJI:
(A)
SO, FT, X $/SQ, I IITEM
M;rin
Garage
Carport
Total Value
Building Pernrit Fee
State Surcharge
Total Fee
4-t,p-o
AflaO
,/? 3s
as93-s
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved'SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
Resi(lential tlat lr(s)
Sanitary Sewcr
Water
'Storm Sewer
Mobile Home
FEE
(c)
t=T.
NU
FI,
FT.
Plumbing Perrnit
state surcharqe
Total Cllarge
PLUMBING PERMIT
ITEM
Fixtures
Woocl Stove/ lnsert / Fi repl:rce tJnit
Dryer Vent
MECHANICAL PERMIT
(D)
N0
Mcr:ltarticitl Ptrrtrti t
lssLrance
State Surchar(Jt)
Total Permit
Fu rn ace
Exhaust Hood
Vent Fan
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 tlre City of Springf ield, and the Laws
of the State of Oregon pertalning to the work described
herein, and that NO OCCUPANCY will be made of any
structure without perrnission of the Building Safety Division.
I further certify that only contractors and employees who
are in cornpliance with ORS 701.O55 will be used on this
proiect.
I f urther agree to ensure that all required inspections are
requested at the proper time, that each address is readable
f rom the street, that the permit card is located
of the property, and the approved
sig
Date
the f ront
of plans ill remain
rU
q--g)
on the site at all tim*,du
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk *----- {t
Curbcut -,----. --
f t
Demolition
State Surchar0e
Total Miscellaneous Permits (E)
VALIDATION:
RECEIPT NUMBER t4. (a)2
q
DATE PAID
AMOUNT RECEIVED
ntrCElVI:tl BY
TOTAL AMOUNT DUE (excltrclirrg olr:<;ttir;al)
(A, B, C, [), :rtrrl [-- Cc,rtltlrinetl)
as? 3<
5 asa3<
N
sl
t:
ACC-
og __
SPTilNGFTEL()
225 FIFTB STREET t):, ,
SPRINGFIEIJ, OREGON 97477
INSPECTION REQT'BST.. 726_3769
OFFICE: 726-3759
1 ON
\lAt tr)
Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for
180 days.
2. cotrTRACf,oR ONLY
Electrical Contracto
Address
Phone 1
Superv i sor cense Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of sing Blectrician
rs Name
PBB SCEEDULB BELOIT
A. Nev Resid en ial-Single or
HuIti-Family per dvelling unit.
Service Included:
Items Cost
L000 sq.ft. or 1ess
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular DveIling
Service or Feeder
s 8s.00
s 1s.00
s 40.00
Services or Feeders
Installation, Alterations or
Relocat ion :
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps _601 amps to 1000 amps_
Over 1000 amps/voIts
Reconnect Only ,r.
c Temporary Services or Feeders
Installation, Alteration or Relocation
D. Branch Circuits
Nev, Alteration or Extension Per Pane1
one cireuit $ 35.00
Each Additional
Circuit or with Service
or Feeder Permit $ 2.00
200 amps or less $ 40.00
201. amps to 400 amps _ $ 55.00
0ver 401 to 600 amps _ $ 80.00
Over 600 amps or 1000 volts see I'8" above
TIONg1
0r
Sum
B
Ci ty
T
$ s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
+rrAddress
Ci ty Phone
OIINER ALLATION
The installation is being made on
property I own vhich is not intended
for sale, Iease or rent.
0vners Signature:
DATE:
RECEIPT
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation $
Sign/Out1ine Lighting_ $
Limited Energy/Res $
Limi ted Energy/Comm $
SIETOTAL OF ABOVB
5Z State Surcharge
TOTAL
E not included)
40.00
40. oo
20. o0
C
I,Y){RECEIVED BY:
5 @
1.
!ho
Ci ty Job Number
a
.{.."i{0S
Qet,D\
65
l