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HomeMy WebLinkAboutPermit Building 1999-07-15SPRINGFIELO D EV E LOP M ENT S ER VIC ES DE PARTM E NT h,225 FIFTH STREET SPRINGFIELD, OR 97477 (541 ) 726-3753 FAX (s41) 726-s68s C'TY OF SPRINGFIELD, OREGO'U Manufactured llome Placement Permit Application City robNumber: ?f?fg 7 Placement Location: /57 /Z'! gr ,/,t( Sznrro -L/,uz, /Yoaru //oue I )unae \ Assessors Map Number: Lot: /H Tax Lot Number: Block:Subdivision: {,,ztl/^t ct rg ct) Partition Number:Parcel Number:Has Partition Been Approved?: --oWNER-- R /'/ueuer<Phone Number: q4 + 91 o + Mailing Address: /an 6eee^t Aczes (4 City:fuesna stile: OA zip:I7Wg --CONTRACTORS.. 1r ltori l/ n, s.rzurca CCB#:/tlzto8 exp: J'z?'@@ phone: ? ( l-golz l) ccB#: 04 z7o (nxp: lo -/ -?? pvon"' 741 '8 a tzPlumbing: Electrical:/t L?7 HO/Exp: '7'2?aa pnone:747 -8c I ?- General Contractor: (if applicable) Exp:_ Phone:_ Mechanical Contractor: (if applicable) Exp:_ Phone:_ --LENDING INSTITUTE.. Business Name:,y la Phone Number: Mailing Address: Attention: State:_ -.PERMIT INFORMATION.. Value of occ o10_ Value of Footing/Foundation: Sq Footage of Home: .;76 Type of Heat, ,E fi Heat Pump Installation?: Sq Footage of Garage/Carport:elL:x Application Received By: Plan Check Fee: Date Receipt Nu*b".:_ Incfallpr. Zip:_ Permit #fa Address: / 5 7 4 Issued bv:J Date Statement: Information Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701 .05 5 (4), requires residentiql construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exemptfrom registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and2, and either box 34 or 38 @ 4. I own, reside in, or will reside in the completed structure W 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3A.. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR l7Ttl\ 2B.. I will be my own general contractor.lI' | / If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certiff that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. 7-ti.7t of permit applicant) fi\rhite copy to issuing ogency permit file, pink copy to applicant) W gnature (Date) /,'/rr f C'TY OFSPB OFEGO'U -rnaNgraGLu .l 225 FIFTB STREEf, SPRTNGFTELD, oREGoN 97477 INSPECf,I0N REQIIESTz 726-3769 0FFICE: 726-3759 EIJCIRICAL PERHIT APPLICATION 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Hanuf'd Eone- or -Hodu1ar.'Dvelling I Service or Feeder / B. Services or Feeders Installation, Alterations $ 1s.00 S 4o.oo {o 41ofe7 1. IOCATION /57 OF INST.ALI,ATION--/i{ b -// DESCRTPTIONf.t/ OC2D I JOB DESCRTPTION 1^ it,/, t-+ Pernits are non-transferable and expire lf vork is not started vithin 180.days of issuance or if sork is suspended for 180 days. City Job Nunber COHPLETE FBE SCBEDT'LE BELOV Nev Residential-Single or MuIti-FamiIy per dvelling unit. Service rncluded' , aurns cos t 3 A IJGAL i'7 07 ' 400 amps 600 amps amps volts lTSHALTEXPIRE Sum s 8s.00 $ s0.00 s 60.00 $100.00 $130.00 FraEorcRK _ 2. COIITRACTOR INSTAIJ,ATION ONLT Elec trical ContractoATTEN f tON or Relocation: Oregonru Address il or to to less 52-001 -001 0 through CAR Ct ty c*Emay-*tarrctes cf th e Supervisor Li the center. (Note: the t Expi ra t ion Center is 1 -80n-i32-2344). constr contr. Number Expirat Signature of Supervising Electrician D Ovners Name 4/acv ATJTHORIZED UNDERTHIS PERMIT IS NOT I ; H : i fd,il8,H',"d{fi bdB,af;fi $Bq,na EoR o n ANY 180 DAY PERIOD. 2oo ampi''or- IEsi -- $ 4q. oo ,oi ffi; i; ioo amps - I ::.99 -over 4b1 to 600 ambs ] $ 80'00il;; doo .*pi-ot-i6oot,'t" see rB'r a566 Branch Circuits ; .' Nev, Alteration or Extension Per Panel -Each installation Pump or irrigation Sign/OutIine Lighting- Limited EnergY/Res - Limited EnergY/Comm ules are c. ion Date Address iO 2 "Acn., il ci Phone ?"q fL6tl One Circuit Each Additional Circuit or vith Service or Feeder Permit $ 3s.00 $ 2.00 Miscellaneous (Service/feeder not included) OIINER INSTALT,ATION The installation ls being made on property f ovn vhibh is not intended for sale, lease or rent. 0sners Signature: lr $ 40.00 $ 40.00 $ 20.00 $ 36.00 lo-,,1.bu i. "t)44t" ozt 5 SUBTOTAL OF ABOVE "l9cState Surcharge 32 Administrative Fee TOTAL DATE: RECEIVED B -t D P,l!NGFIELDRESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office:726-3759 LOCATION OF PROPOSED WORK: ?Eo qt 7JOB NUMBER 225 Fifth Street Sprlngf leld, Qregon 97 477 lf7 / zt f'{/ ASSESSORS MAP:/703 3 f ./t TAX LOT OoZot LOI BLOCK:SUBDIVISION PHONE: 7 qdZIP:AASTATE: 7t7 szo Ll CITY: ADDRESS: OWNER: DESCRIBE WORK: NEW - REMODEL ADDITION DEMOLISH OTHER - ADDRESSt 'dt ,$ PHONE 6lzzo CONTRACTOR'S NAME MECHANICAL: ELECTRICAL: EXPIRES PLUMBING: GENERAL: CONST. CONTBACTOFI # ITISNOT FOB WORKnot$$'eggB. obtain co[r!eS THIS Notification res you t{,OUAo ABEA: ATTEN llON FLOOD I)LAIN: follow rules TlCfS*,*G coDE:# oF BLDGS:#enler.Tfi&f occY GRouP: inOAR952-001 0090. You maY* OF STORIES:center.$mEffPU numberforthe OWATER HEATER 1800fi$ffi6Bornc - OFFICE USE - To request an lnspectlon, you must call 726-3769. Thls ls a24hour recordlng. All lnspectlons requested before 7:00 a.m. wlll be made the same worklng day, lnspections requested after 7:00 a.m. wlll be made the followlng work day. REOUIRED INSPECTIONS Temporary Electric Rough Mechanlcal - Prior to cover.[-l Ftnat Plumbing - When altlJ plumbing worl< ls complete. tl E tl l--l Drywall - Prlor to taplng. Wood Slovo - After lnstallatlon.tl E [f Pctt rnd Bcem - Prior to floorl-r lnruletlon or Caoklng.rf Slto lnspectlon - To be made after excavatlon, but prior to setting forms. Underslab Plumblng/ Electrlcal/ Mechanlcat - Prlor to cover. Foollng - After trenches are excavated. Masonry - Steel locatlon, bond beams, groutlng, Foundatlon - After forms are crcctcd but prlor to concrete placemont. Underground Plumblng - Prior to fllllng trench. Underlloor Plumblngl Mcohanlcal - Prlor to lnsulatlon or decklng. Floor ln:ulation - Prlor to decklng. Storm Sewer - Prior to fllling trench. Water Llne - Prlor to filling trench. Rough Plumbing - Prior 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. WalllCblllng lneulatlon - Prlor to cover. Flnal Electrlcal - When all electrical work ls complete. Final Mechanlcal - When all mechanlcal work is complete. Flnal Building - When att requlred lnspectlons have been approved and buildlng is completed. Othsr MOBILE HOME INSPECTIONS -r: ln!.rl - Attar ,ltopl.o. rpprcval and lnstallatlon ol unlt. Curbcut & Agrprorch - After forms are erected but prlor to placement ol concrete. Sidewall< & Drlvewav - After excavation ls complete, forms and sub-base material ln place. Fence - When coinpleted. $treet Trees - When all requl trees are planted. B and Set.Up - When altl. ecmpl.ri, mblng Conntotlonr - When homo lrae been connected to water an<l sewer. Connection - When blocklng, set-up, and plumblng lnspections have been approved and the home ls connected to the servlce panel. F - After all required spections are approved and porches, sklrting, decks, and ventlng have been lnstalled. ,/\l-l Sanitary Sewer - Prior to flllinglJ trench. ) l-lNlT-q,rrr epl tr'rr"; E E tl Lot faces Lot sq. ftg. Lot coverage Topography Total helght Lot Typ _ - lnterior - Corner - Panhandle ! - Cul-de-sac Setbacks PL.HSE GAR ACC' N I S E IS THE PROPOSED WORK TN THE .. HISTORICAL OISTRIGT, OR ON THE HISTORICAL REGISTER? - lf yes, this applicatlon must be slgned and approved by the Hlstorlcal Coordinator prlor to permit issuance. APPROVED: VALUE (A) fitrr* r t Total Value Building Permit Fee State Surcharge Total Fee FT. X $/SO. FT. EUILDING PER ITEM SQ. Main Garage Carport BUILDING VAIUT, I,MII CHECK AND BUILDING PERMIT Thls permit is granted on the express conditlon that the sald construction shall, ln all respects, conform to the Ordinance adopted by the City of Springfield, including the Dovelopment Code, regulatlng the constructlon and use of buildings, and may be suspended or revoked at any tlme upon violation of any provisions of said ordinances. Plans Reviewed By Date Plan Check Fee: Date Paid: Receipt Num Received By: SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. ITEM Flxtures Residentlal Bath(s) Sanitary Sewer Water Storm Sewer Moblle Home t{.ou i .ro FEE t,J (c) N' FT. /l f" PLUMBING PERMIT Plumblng Permlt State Surcharge Total Charge ADDITIONAL COMMENTS By slgnature, I state and agree, that I have carefully examlned the completed application and do hereby certlfy that all lnformatlon hereon is true and correct, and I f urther cerilfy that any and all work performed shall be done in accordance wlth the Ordinanccs of the City of Sprlngfield, and the Laws of the State of Oregon pertainlng to the work descrlbed herein, 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 ln compliance with ORS 701.055 will be used on thls proiect. I further agree to ensure that all required inspections are requested at the proper tlme, that each address ls readable from the street, that the permlt card ls located at the front of the property, and the approved set of plans will remaln on the site at all times during construction. /5 Slg natu re Date Wood Stove/ lnsert/Flreplace Unit Dryer Vent MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sldewalk - ft Curbcut - ft Demolltlon State Surcharge Total Mlscellaneous Permits (E) -d) 0, fb /"/(-7) a Vent Fan (D) MECHANICAL PERMIT Fu rnace Exhaust Hood N0 Mechanical Permlt lssuance State Surcharge Total Permit I )o VAI-IDATION: RECEIPT NUMBER DATE PAID AMOUNT RECEIVED RECEIVED BY ]ttstz TOTAL AMOUNT DUE (excluding electrical) (A, B, C, Q and E Comblned) tl. - t;,1 FT. FT. ?" 7l "