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 "