HomeMy WebLinkAboutPermit Demolition 1997-09-16SPRINGFIELEl
RESIDENTIAL
PERMIT APPLICATION
lnspec'
Of f ice:
tions: 726-3769
726.3759
JoB NUMBE a a2l >>4
225 Fifth Street
Sprlngfleld, Oregon 97477
LOCATION OF PROPOSED WOBK:
ASSESSORS MAP:TAX LOr.l @a a\
LOT:BLOCK:SUBDIVISION
D,n.zte: 4)71-STATE:
E:
CITY:
ADDRESS:
OWNER:
ELECTRICAL:
ADDRESS
T
EXPIRES .1 PHONE
GENERAL:
MECHANICAL:
PLUMBING:
CONST.
CONTRACTOR #
RANGE:
_ OFFICE USE -
LAND USE:
WATER HEATER
ZONING CODE:g OF UNITS:
QUAD AREA:
I OF BLDGS:
SECONDARY HEAT:
SQUARE FOOTAGE:
, OF BDRMS:
-
OCCY GROUP:
r OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspectlons requested belore 7:00 a.m. wlll be
made the same worklng day, lnspections reguested after 7:00 a.m. wlll be made the followlng work day.
REOUIRED INSPECTIONS
Temporary Electrlc Rough Mechanlcal - Prlor to
cover.
Flnal Plumblng - When all
plumbing worl( ls complete.
Slte lnspectlon - To be mado
after excavation, but prior to
setting forms.
Rough Electrlcal - Prlor to Flnal Eleclrlcal - When all
electrical work is complete.cover.
Underslab Plumblng/ Electrlcal/
Mechanlcal - Prlor to cover.Electrlcal Service - Must be
approved to obtaln permanent
electrlcal power.
Final Mechanlcal - When all
mechanical work ls complete.
E Footlng - After trenches are
excavated.Flnal Building - When all
required lnspectlons have been
approved and bullding ls
completed.
Flreplace - Prlor to faclng
materlals and framlng lnsp.
Masonry - Steel locatlon, bond
beams, groutlng.fl
E
Framlng - Prlor to cover.
Foundatlon - After forms are
erected but prlor to concrete
lplacornont.
w Othor
WalllCelllng tnsutatlon - Prlor to
cover,
Underground Plumbing - Prior
to fllllng trench.l--l Drywatl - Prlor to taplng.
Underlloor Plumblng/ Mechanlcal
- Prior to lnsulatlon or decklng.
MOBILE HOME INSPECTIONS
Wood Stovo - After lnstallatlon
Post and Beam - Prlor to floor
lnsulatlon or decklng.lnsert - After flreplace approval
and lnstallatlon of unlt.
n Blocking and Set.Up - When ailu blocklng ls complete.
Floor lnsulatlon - Prlor to
decklng.[_l Curbcut & Approaclr - After
'J forms are erected but prlor to
placoment of concrete.
Plumbing Connectlons - When
home has been connected to
water and sewer.
W?fr:Wewer - Prior to,rrrns
[-l Storm Sewer - Prior to fllllng
-
trench.
Sldewalk & Drlveway - After
excavation ls complote, forms
and sub-base materlal in place.
Electrical Connection - When
blocking, set-up, and plumbing
lnspections have been approved
and the home is connected tothe servlce panel,
Water Llne - Prlor to filllng l-l Fence - When coinpleted
trench.Flnal - After all required
lnspectlons are approved and
porches, sklrtlng, decks, and
ventlng have been lnstalled.
Rough Plumblng - Prlor to Strcet Trees - When all requlred
trees are planted.cover.
24,/^77?./
DESCRIBE WORK:
NEW
-
REMODEL ADDITION DEMOLISH OTHER
CONTRACTOR'S NAME
FLOOD PLAIN:
E
E
E
tl
tl
E tl
E
. rt:; ::
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
t-ot Type
-
lnterlor
-
Corner
-
Panhandle
-
Cul-de.sac
'S THE PROPOSED WORK TN THE "
HISTORICAL DISTFIICI, OR ON
THE HISTORICAL REGISTER?
-
It yes, thls appllcailon must be slgnedand approved by the Historlcal
Coordlnator prlor to permit issuance.
APPROVED:
PL.HSE GAR ACC
N
S
W
E
VALUE
(A)
BUILDING PERMIT
Total Value
Bullding Permit Fee
State Surcharge
Total Fee
:h, ,l i
X $/SQ. FT.SQ. FT.ITEM
Maln
Garage
Carport
BUILDING VALUe, ptRtt CHECK
AND BUILDTNG PERMIT
This permit is granted on the express condition that the saldconstruction shall, ln all respects, conform to the Ordinanceadopted by the City of Springfleld, includlng theDevelopment Code, regulating thE construcilon and use ofbulldings, and may be suspended or revoked at any tlmeupon violation of any provisions of sald ordinances.
Beceipt Number:_
Plans Revlewed By
t
Date
Plan Check Fee:
Date Paid
Received By:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge ls due on all undeveloped
properties withln tlre City limlts which are belng lmproved.
ITEM
Flxtures
Resldentlal Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
N'
./6, >
FEE
rr. z?
FT.
FT.
4'
(c)
PLUMBING PERMIT
Plumblng Permlt
Stale Surcharge
Tolal Charge
ADDITIONAL COMMENTS
By slgnature, I state and agree, that I have carefully examlned
the completed appllcatlon and do hereby certlfy that all
lnformatlon hereon ls true and correct, and I lurther certlfy
that any and all work performed shall be done in accorrJance
wlth the Ordinances of the City of Sprlngfietd, and the Laws
of the State of Oregon pertalnlng to the work descrlbed
hereln, and that NO OCCUPANCy will be made of any
structure wlthout permission of the Bulldlng Safety Dlvislon.
I further certify that only contractors and employees who
are ln compliance with ORS 701.055 wlll be used on thls
proiect.
I further agree to ensuro that all requlred lnspectlons are
requ€sted at the proper tlme, that each address ls readable
from tho street, that the pormlt card ls located at the lront
of the property, and the approved set of ptans will remaln
on the slte at all times durlng construcilon.
Date 1'ta -za
Slgnature
Wood Stove/ lnsert/Flreplace Unlt
Dryer Vent
MISCELLANEOUS PERMITS
Total Mlscellaneous Permits (E)
d
- ,u/
Demolltlon
State Surcharge
_G.-/5--;37
(o)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan No
Moblle Home
State lssuance
State Surcharge
Sldewalk
-
ft
Curbcut
-
ft
Mechanlcal Permlt
lssuance
State Surcharge
Total Permlt
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)RECEIVED BY
QoAMOUNT HECEIVED
DATE PAII)
VALIDATION:
RECEIPT NUMBER
a Z,-Z*.r*
DEPARTMENT OF FIRE & LIFE SAFETY
OPERATIONS
SPFIINGFIELc,
d
FD- I 58
225 FIFTH STREET
SPRINGFIELD, OR 97477
(503) 726 37s7
FAX (503) 726 2297
Area Code changes to (541)
November 1995
.t.
h,
TRAINING BURN AUTBORIZATION
Date:.-1
L)
TO:City of Springfield, a Municipal Corporation, acting by and tfuough its Department of Firc
and Life Safety
You are hereby authorized and pcrmitted to burn under supervision and for education and instruaion
purposes Orat certain house or building located on:
Tax lot # BW , in
-Addition
to Springfield,
-J s/1!Oregon which is desigruted as Springfiel( Oregon
L/We, cxpressly warrant and represent to you that I/We, the undersigne( are the owner(s) of said propcrty,
and tlut the same is free and clear of any and all liens, encumbrances, judgments, and any interesl, nght,
title or claim in any other person other than the undersigne4 and that this mnsent is freely and
voluntarily given, and tlut we will save the City of Springfield harmless from any liabiliry to any pcrson
whomsoever by reason of any statement or warranty contained in this letter.
I/We, the undersignd also agree to the following requirements imposed by the Department of Fire and
Life Safety to assure completion of all regulations.
l. The property owner(s) shall remove all debris on the lot(s) involved in this burn
within sixty (60) days after completion date of the burn by the Department of Fire
and Life Safety.
2. The property owner(s) is to sectue the required demolition and plumbing cap
permits from the Building Department when inside the City Limits.
3. Ouside City Limits, Coung regulations apply.
4. The property owner(s) shall have the structure inspected for asbestos. This
includes:
a. An internal and external inspection of the strucnre by an asbestos or
environmental consulting firm.
b. Removal of asbestos 6pnteining materials, as indicated by the inspecting
firm.
l. An Owner-occupant may perform asbestos removal.
a. The Waste Shipment Record (ASN4) musr be filled outb. Setup an appointment with Short Mountain kndfill -
6874120 - for disposal.
2. [f not an owner-occupan! a removal company must perform
ashstos removal and disposal.
c. The property owner(s) shall submit a copy of the original asktos inspection as written
by the inspecting firm and a signed note stating that the asbestos has been removed.
rf
ADDRESS a,+:..-\v1 '-J')
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