HomeMy WebLinkAboutPermit Building 1992-10-08SPFIINGFIELL)
RESIEEN-'AL
PERMIT APPLICATION
lnspections: 726-3769
Of fice: 7?.6-3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP
LOT:
JOts NUMBEFI .
225 Fif th Strer:t
Spr irrgllcltl, Orc11<.rtr 1)747 Z
7z/z 5/
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I]LOCK:SUBDIVISION
STATE: -.--
L 7_7Lb_l4eaaz-4F
ADDRESS:
CITY:
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ADDITION
4{24
L
DEMOL|St-t ___
4--4-
NEW .,--- nEMolJ[L
EXPIRES PHONEADDFIESSCONTRACTOR'S NAME
GEN.ERAL:
-
-e-WA)4-
CONST,
CONTFIACIOR /
I)LU MIJING:
MLCFIANICAL: .
Et-t:CTRICAL: -
QTJAD AREA: -,-
s OF BLDGS: /
occY GRoL to, - *7 /
, OF STORIE T, -- - /
WATER HEATER: -
F'I-OOD PL.AIN:
ZONING CODE: -
, OF BDRMS:
SECONDABY HL,AT: .
SQUARE FOOTAGE:/lloRANGE: - -
_ OFFICE IJSE _
I.ANt) USE:
, OF UNITS: .
CONSTFI. TYPE: ._ V=N
HEAr souRCE: --- lvdil E
To reque$t an inspection, you must call 726-3769. This is a24hour recor<lit'tg;. All inspcctions re<luested before 7:00 a.m. will be
made the same working day, inspections requested after 7:00 a.nr. will Lle rnade the following work day.
REQUIRED INSPECTIONS
Temporary Electric Rough Mechanical * Prior l<,t
cover.
l-l Final Plumbing - When allL J plurnbing work is cotnplcte.
Sile lnspection - To be madc
after excavation, but prior to
setting lorms.
Underslab Plumbing/ Electrical i
Mechanical - Prior to cover.
Footing - After lrenches are
excavated.
Masonry - Stcr-'l locatlon, t-rotttl
bcarns, groutltrg.
Foundation - Afler forms are
erected but prior lo corlclcte
placement.
Underground Plumbittg - Prior
to filling trench.
Underlloor Plumbing/ Mechatrical
- Prior to insulation or decl<ing.
Post and Beam - Prior to floor
insulation or decking.
Floor lnsulation - Prior to
decki ng.
Sanilary Sewer - Prior to f illing
trench.
Storm Sewer - Prior to {illing
lrench.
Water Llne - Prior t<; filling
lrench.
Rough Plumbing - Ptior tcl
cover.
Rough Electrical - I)t'iot to
cover
Electrical Service - Mrtst lrrr
approved to obtairl L)orlT).irl()lll
elcclrical power.
Fireplaco - Prior to facitrc;
materlals ;rrrtl f rarrrlng lttslr.
l- -l Final Electrical - Wherr allL- | electrical work is r;<.rtttplele.
r_l
tl
,X
L_i
L]
t_l
D(
Final Mechanical - When all
mechanical wotk is; r;omplele.
Final Builcling - Wltert all
required insper;tions ltave bcen
approved anrl lrrrilrlirr<; is
r; clr r r plol etl.
-l OllretE(ttotttt"g - Priot to o()vcr'
Wall/Ceililrg lttsttlirliotr -- l'tirrr lcr
cover
Drywall - Prior to tapitrgl
Wood Stove - Af ter installitlion
lnserl - Alter f ireplace approval
and lnstallation of unit.
Curbcut & Approaclt - Af tr:t
fornts are erectr:r-l but ptir.rt ttr
placernent of concrete.
Sidewalk & DrivewaY - Af tct
ex<;avation is cornPlete, fottns
antl sub'basc trtirlrlrial itl 1.rl;tr:'.r.
Fence -- Wlten comPlolr-'tl
Slreet Trees - When all rerlttirorl
trees are plantecl.
MOBILE HOME INSPE TIONS
Blocking and Set-Up - When all
blocking is complete.
Plumbing Connections - When
t)ome ]ras been corrnected to
water and scwer.
L_l Eleclrical Connection - When
blocking, set-up, and plumbing
inspections lrave been approved
:rn<l tlrc hornc is corrnectecl to
llrc s;ervice parrel.
| ' -l Final - Altr:r all rerluiredt-J irrspcctions are approved arrd
porr;116'5, skirting' decks, and
vnntine lravr: been irrstallcrl.
/7oz-
.'II':
1
tl
tl
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tl
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fJ
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Lot laces
Lot sq. ftg.
Lot cover.rge
T<.rpograplty
Total height
t,ot [y1rr:
. ltttct'icir
Corrlr-'r
[)anltirtrtlle
Cul-tlc-:;;tc
Stltbacks
Pr I
NI
I-iSE ACC
THE PROPOSED WOR(.IN {HE
}JISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
--lf yes, this application must be signed
ancl approved bY the Hlstorical
Coorctinator prior to permit issuance.
APPROVED:
!)
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This pt:rtnit is grantt-'ri on the express condition that the said
c()nstr(r(:tlon :ih;rll, in iill rcsllects, conforrtt to the Ordinance
acloptecl by the City of Springfield, including the
Developtnent Coclc, regrllating lhe construction and use of
brrilclings, ancl may be suspended or revol(ed at any tirne
violation of any provisions of said ordinances
Reviewed By
v:
_e-T
7a1
u porl
7/,e3Plan Check Fee: -.
Date Paid
Receipt Nurnller:-.
Received
A1e4*f/L4e. O,o&oa>)
BUILDING PERMIT
VAI,TJE
toy'o
(A)
SQ. FT. X $/SO. I'I
/5,OCD
ITEM
M;iirt
Garage
Oilrport
Total Value
Building Permit Fee
State Surcharge
Total Fee
//o,'o5f3
Systems Developmcnt Charge is due on all undeveloped
properties within the City limits which are being improved.SYSTEMS DEVELOPMENT CHARGE (SD ctK
(B)
g
ADDITTONAL COMMENTSPLUMBING PERMIT
ITEM
Fixt u res
Residential Batlr(s) Nu
Sanltary Scwcr t--T'
water l 1,
FEE
(c)
Plumbing Perrnit
State Surcharge
Total Charge
Slorat Sewer
Mobile Home
Woocl Stove/ lnsert / Fi replace Unit
Dryer Vent
MECHANICAL PERMIT
(D)
N0
M<:clt;rtric;tl [)r:t ttli t
Is:; r.r;tt t cc
State Surcl);rr(lc'
lotal Pertnit
Fu rnace
Exhaust Hoocl
Vent Fan
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that all
information hereon ls true and correct, and I f urther certify
that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertalning to the work descrlbed
herein, and that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
I further certify that only contractors and employees who
are ln compliance witll ORS 701.055 will be used on this
projcct.
I f r-rrtl-rer agree to ensure that all required 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 the etpproved set of plans wlll remain
on the slte at all times during co--ns(ruction.
14Slg natu re
2 'z--2C
Date -
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sldewalk -_- ft
Curbcut
--
ft
Demolltlon
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excludin0 electrioal)
(A, R, (), f), ;ittrl li Corrthinrlrl)
VAt-IDATION:
BECEIPT NU
DATE PAID
AMOUNT I
//0,o'nf CE lV t: t)Y
EIV
/ol/"L' / D{re//b.ao
225 RIYIH STRBET
SPRTNGPIELD, oRBGON 97477
INSPECf,ION BEQUBST: 726-3769
OPFICE: 72:,6-3759
1
1">o o
Addt""s
permits are non-transferable and expire
if vork is not started vithin 180 days
of lssuance or if vork is suspended for
180 days.
2. COIIITACTOR INSTALI,ATION ONLY
Electrical Contractor 6lfinu--
Ci tv Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Exoiration Date
Signature of Supervising Electrician
/
t)),
BT,ECTRICAL PERilIT
Ci ty Job Number 7t25 I
3. CO}IPI..BTE PEB SCEBDT'LE BELOS
A. Nev Residential-Single or
HuIti-FamiIy per dvelling unit.
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Hanuf'd Home or
-Hodular DveIIing
Servlce or Feeder
Services or Feeders
Insta1lation, Alterations
or Relocation:
$ 8s.00
s 15.00
$ 40.00
c.
One Circuit $ 35.00
Each Additional
Circuit or rith Service
or Feeder Permi.t (/' $. 2,00
Temporary Services or'Feeders
Installation, Alteration or Relocation
200 amps or less -S 40.00
201 amls to 4oo amps
-
$ 55.00
over 4b1 to 6oo amps
-
$ 8o.oo
Over 600 amps or lbOO-ToTts see 'Bu a566
Branch Circuits
New, Alteration or Extension Per Panel
4:,
SPFI]{GFIELE,
STIBTOTAL OF ABOVB
5Z State Sutcharge
TOTAL
not included)
40.00
40.00
20.00
e=.e
Sum
lA rl,D SXt oP
t/h
B.
E.
$ so.
$ 60.
$100.
$130.
00
00
00
00
00
00
e
$300
$40
Owners
Address
Name
uw €P4l- pno""l4-"/ Y(t2{
OIJNER INSTALI,ATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Signa
MiscelLaneous ( Service/feeder
-Each installation
Pump or irrigation
-
$
sign/outline Lighting- $
t,imi ted Energy/Res
-
$
a6D1-
7/uu
QZ,
C'TY OF SPR"UGFIELD, OBEGO'U
RECBIVED
,ture:
/'rr0
5 Z-6o
200 amps or less :201 amps to 400 amps _401 amps to 600 amPs _
601 amps to 1000 amPs_
0ver 1000 amps/vo1ts
Reconnect 0nly
Permit No:
Address:
lssued Date:
OR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSI BILITIES
Fill in the plicable blanks, and initial boxes 1 and 2, and either box 3A or 38
I own, reside in, or will reside in the completed structure
3.A
I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
My general contractor is ,
Note: Oregon Law, ORS 701.055(4), requires residential construction permitapplicants who are not registered with the Construction Contractors Board tosign the following statement before the building permit can be issued. This state-ment is required for residential building, elecfrical, mechanical, and plumbing
permits. Licensed Architect and Engineer applicants, exempt from registration
underORS 701.010(7), need not su6mit this statement. This statement wiil befiled with the permit.
1
2
OR
Contractor registration n
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
3.B I will be my own general contractor.
lf I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. lf I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
and I will immediately notify the office issuing this building permit of the name of
the contractor.
I hereby certify that the above inlormation is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of this
/4
Si re Perm A p a
CONSTRUCTION CONTRACTORS BOARD
0244J 8t91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT