HomeMy WebLinkAboutPermit Building 1995-09-13SPFlII\lGFIELD
RESIDENTIAL
PERMIT APPLICATION
lnspectlons: 726.3769
Ofllce: 726.3759
LOCATION OF PROPOSED WORK:o
ASSESSORS MAP:
LOT:
PHONE:
ot2-ZIP:
-r+t\
ar*te--
STATE:\
4ss -tz-l
CITY:E.rc,
OWNER;
ADDRESS:
q3o2-I
DEMOLISH OTHER
DESCBIBE WORK:
NEW-- FIEMODEL X ADDITION
ADDFIESS
E,j.c q z.so6
CONST.
CONTRAoToR #EXPIRES PHONE
-G-)
CONTRACTOR'S NAME
ELECTRICAL:
GENEBAL:
MECHANICAL:
PLUMBING;
FIANGE:
r OF BDRMS:
WATER HEATEB:
- OFFICE USE -
LAND USE:
I OF UNITS:
OUAD AREA:
* OF BLDGS:FLOOD PLAIN:,
ZONING CODE:
SECONDARy HEAT:
SQUARE FOOTAGE;
OCCY GROUP:
r OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspectlon
made the same worklng
n femporary Electrlc
Slto lnspecilon - To be madeafter excavatlon, but prlor tosettlng forms.
fl:*:,lr"i!,t?i 3i i5, :c
r r, c a, /
I--l Footlng - After rrenches are
-
excavated.
[-f y-asonu - steet tocaflon, bond
-
beams, grouilng.
f] s[i::#"it,, ;, #tr J:ili,T"
fl lrng:tnround ptumbtng _ prlo,
-
to fllllng trench.
fl 3 E:,l,"iJ,?,:ffL,:i' y,T::[,,ff
:
f-ost a.r.rd Beam _ prlor to floorInsulailon or decklng.
Floor lnsutatlon _ prlor tooecKtng.
Sanltary Sewer - prlor to fllllngtrench.
31"-rl Sewer - prtor to filtngrrench.
Y:l:r.Ltne - prtor to fliltnsrrench.
, you fiust call 726-3769. Thls ls a 24 hourday, lnspecilons requested after Z:OO a.m
REQUIRED INS
[-l nough Mechanlcat - prtor toH cover.
' recordlng. All. lnspecilons
. wlll be made, the foilowln
PECTIONS
requested before 7:00 a.m. wlll beg work day.
E 5ll;l'?[T"'j:*' ;"y,1 ;i" il:
E 5,',::1,,:fi*::1,, l"H;i",xl.
ffi Flnal Mechanlcal _ When all---: mechanlcal work r"
"orp"rei"l
E
F:{ii."'Jif:?g";, # i3,,x,,0
" " "approved and bulldlng l;- --"'.
completed.
lIl I;#, Electrlcat - Prror to
-Electrlca.l .servtce _ Must be
3iJ#ti i'"fl:::'' Permane n t
fl rtrentace - prto'r to faclngH matertals and rramrnglispl
ffi Framlng - Prlor. to cover.
f] y:ttt"blilns tnsutailon - prr.jr.to
-
cover.
ffi orvwalt - Prror to taprng.
I Wood Stovo - Aft6r lnstallailon.
ln"glt - After ftreplace approvaland lnstallailon of 'unlt.
Curbcut & Approach _ Afterrorms are erected but prlor toptacement of concrete.
Sldewalk & Drlveway - After i
excavailon ls compieto, forms ..and sub.base malerlal in ptace.
Fence - When completed.
MOBILE HOME INSPE TIONS
[-l etocklng and Set.Up _ When ail
-
blocklng ls complete.
Other
ffi nouet plumblng - prtor to
-
cover.fl i*:t"["n;flen arr requrred
, IllToinn Connecilons _ whenh.ome has been connectec, towater and sew?r.
fl$i#f""'#:#*:#ir,:.an_d the.home ls connected tothe servlce panel.
,li!"t - After alt requiredrn_specilons are appioved and
9"',li,i?: ; iH'.?h., :"T: i, #
i ..
JoB NUMBE* QS- on.ro
225 Flfth Street
Sprlngfleld, Oregon 97477
. (al2 (- \<l t
q
\
r
r E
tl
nl "iJ l'
Lot faces
Lot sq. ftg.
Lot coverage
TopographY
Total [elght
Lot Typ
-
-
lnterlor
-
Corner
-
. Panhandle
-
Cul-de'sac
PL.HSE GAFI ACC
N
S
E
S THE PROPOSED WORK IN'THE -
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, thls applicatlon must be slgned
and apProved bY the H lstorlcal
Coordinator prlor to permit isSuance'
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls permit is granted on the express condition that the said
consiruction shall, ln all respects, conform to the Ordlnance
adopted by the City of Sprlngfleld, lncluding the
Development Code, regulating the constructlon and use of
bulldings, and may be suspended or revoked at any tlme
upon virclation of any provisions of sald ordinances'
Plan Check Fee:
DatePlans Reviewed BY
Receipt Numbe
Date Paid:
Beceived BY:
so. FT. x $/so. FT. - VALUE
(A)
5@?'I?g-a+a
-ty
"2-o
l?€
BUILDING PERMIT
Total Value
Building Permit Foo
State Surcharge
Total Fee
ITEM
lv!ain
Gaqage
Carport
Systems Development Charge ls duo on all undeveloped
properties wlthln the City limits which are being lmproved'SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
ITEM
Flxtu res,.
Residential Bath(s)
SanitarY Sewer
Water
Storm SevYer
Mobile Home
PLUMBING PERMIT
FEE
%a
,aLO
Zog3
N0
FT.
FT.
FT,
(c)3 ao
ltl
Plumbirrg Permlt
Stato_ Surcharge
Total Charge
Wood Stove/ lnsert/ Flreplace Unlt
Dryer Vent
MECHANICAL PERMIT
loe
t20
?nZb(D)
N0
Mechanical Permit
lssuahce
State Surcharge
Total Permit
Fu rnace
Exhaust Hood
Vent Fan
By slgnature, I state and agree, that I have caretully examlned
the completed appllcatlon and do hereby certlfy that all
lnformatlon hereon lS true and correct, and l f urther certlty
that any and all work performed shall be done in accordance
wlththeordinancesoftheCityofspr|ngfie|d,andtheLaws
of the State of Oregon pertalnlng to the work descrlbed
hereln, and that NO OCCUPANCY wlll be made o( any
structure wlthout permission of the Bulldlng Safety Dlvislon'
I further certlry that only contractors and employees who
are ln compllance with OBS 701'055 wlll be used on thls
proiect.
I further agree to ensure that all requlred lnspections are
requested at the proper tlme, that each address ls readable
from tho strest, that tho psrmlt card ls located at the lront
of the property, and the approved set of plans wlll remaln
on the slte at all times durlng constructlon'
Slgnature
Date
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sldewalk
--
lt
Curbcut
--
ft
Demolitlon
State Surcharge
Total Miscellaneous Permits (E)
q5t
AMOUNT RECEIVED
RECEIVED BY
DATE PAID
C>\boooVALIDATION:
BECEIPT NUMBER
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Comblned)