HomeMy WebLinkAboutPermit Mechanical 1998-03-10SPR
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
JoB NUMBE R <A ^ i
225 Fifth Street
Sprlngfleld, Oregon 97477
sr8 il tS J7LOCATION OF PROPOSED WORK:
ASSESSORS MAP;
LOT:
: TAX LOT:
BLOCK:
l
OWNER:
ADDRESS:
CITY:
PHONE:
Y{ZIP:
L
STATE:
d(.Un fir.
NEW
-
REMODEL ADDITION DEMOLISH OTHER
I A"hru k.l"a^dln,DESCRIBE WORK:
ADDRESS PHONE
,r
4li..e USr'1 r...7]'3?I)
tr
0 B
lie-rP
.)o
tl
u ic<)
ELECTRICAL:
GENERAL:
MECHANICAL:
CONST,
CONTRACTOR #CONTRACTOR'S NAME
l(
RANGE:
r OF BDFIMS:
- OFFICE USE -
LAND USE:
WATER HEATER:
ZONING CODE:
FLOOD PLAIN:
E OF UNITS:
OUAD AREA:
# OF BLDGS
SECONDARY HEAT:
SQUARE FOOTAGE:
OCCY GROUP:
* OF STORIES:
CONSTR. TYPE:
HEAT SOUBCE:
To request an lnspectlon, you must call 726-3769. Thls ls a24hour recordlng. All lnspections 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 Electrlc [-l Rough Mechanlcal - Prior to f-T Ftnat ptumbing - When alt|J cover. lJ plumblng work ls complete.
Site lnspectlon - To be made
after excavatlon, but prior to
setting forms.
Rough Electrical - Prior to w Final Electrlcal - When all
electrical work is complete.cover.
E Underslab Plumblngl Electrical /
Mechanlcal - Prlor to cover.Electrical Servlce - Must be
approved to obtaln permanent
electrlcal power.
Flnal Mechanlcal - When all
mechanical work ls complete.
E Footlng - After trenches are
excavated.Flnal Buildlng - When all
requlred lnspectlons have been
approved and building is
completed.
Flreplace - Prlor to faclng
materlals and framing lnsp.
Masonry - Steel locatlon, bond
beams, groutlng.Framlng - Prior to cover.
E Foundatlon - After forms are
erected but prlor to concrete
placemont.
Other
-
tl Wall/Celling lnsulatlon - Prlor to
cover.
Underground Plumbing - Prior
to filling trench.Drywall - Prlor to taping
MOBILE HOME INSPE TIONS
Underlloor Plumblng/ Mechanlcal
- Prlor to lnsulatlon or decklng.Wood Slovo - After lnstallatlon
Post and B€am - Prlor to floor
insulatlon or decking.lnserl - After flreplace approval
and lnstallatlon oI unlt.
Blocking and Set.Up - When alt
blocklng ls complete.
Floor lnsulation - Prior to
decklng.Curbcut & Approach - After
forms are erected but prior to
placement ol concrete.
Plumblng Connections - When
home has been connected to
water and sewer.
Sanltary Sewer - Prior to fllling
trench.Electrical Connectlon - When
blocking, set-up, and plumbing
lnspections have been approved
and the home is connected to
the service panel.
Storm Sewer - Prior to filling
trench.
Sidewalk & Driveway - After
excavation ls complete, forms
and sub-base materlal in place.
Water Llne - Prlor to filling
trench.
Fence - When coinpleted.
$treet Trees - When all requlred
trees are planted.
l-l Flnal - After alt required
'J lnspectlons are approved and
porches, sklrting, decks, and
ventlng have been lnstalled.
Rough Plumbing - Prior to
cover.
E
aEzT z/"av*z/-vz
SUBDIVISION:
-
D(
PLUMBING:
E w
tf
tl
E
{t ,
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Tyt
-
lnterlor
-
Corner
-
Panhandle i'
-
Cul-de-sac
PL.HSE GAR ACC
N
S
E
IS THE PROPOSED WORK TN THE .
HISTORICAL DISTBICI, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this application must be slgnedand approved by the H istorlcal
Coordinator prior to permit issuance.
APPROVED:
BUTLDING PERMIT i
VALUE
(A)
ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
SO. FT. X S/SQ. FT.
This permit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordinanceadopted by the City of Springfietd, including the
Development Code, regulating the construction and use ofbuildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plans Reviewed By Date
Receipt Numbe
BUILDING VJ\LUE,
AND BUILDING PE R
LAN CHECK
iMIT
Plan Check Fee:
Date Paid
Received By:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within tlre City limits which are being improved.
FEE
(c)
N.
FT.
Residential Bath(s)
Plumblng Permlt
State Surcharge
Total Charge
PLUMBING PERMIT
ITEM
Fixtu res
Sanitary Sewer
Water
Storm Sewer
Moblle Home
. FT.
ADDITIONAL COMMENTS
By slgnature, I $tate and agree, that I have caref ully examlned
the completed application and do hereby certify that all
lnformation hereon is true and correct, and I f urther cerilfy
that any and all work performed shall be done in accorrlance
wlth the Ordinances of the City of Sprlngfield, and the Laws
of the State of Oregon pertainlng to the work descrlbed
herein, and that NO OCCUPANCy will be made of any
structure wlthout perrnission of the Building Safety Divislon.
I further certity that only contractors and employees who
are in compliance with ORS 701.O55 will be used on thls
proiect.
I further agree to ensure that all required inspections are
requested at the proper time, 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
0-
Slgnature
Date
on the site times during construcilon.
Wood Stove/ lnsert/ Fl replace Unit
Dryer Vent
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
--
ft
Demolitlon
State Surcharge
Total Miscellaneous Perrnits (E)
TOTAL AMOUNT DUE (excluding electricat) ___---
(A, B, C, Q and E Comblned)
2a<
,,) -frG
(D)
MECHANTCAL PERMIT
Fu rnace
Exhaust Hood
Vent Fan No
Mechanical Permit
lssuance
State Surcharge
Total Permit
V*
2a
DATE PAID
AMOUNT RECEIVED
BECEIVED BY
VALIDATION:
RECEIPT NUMBER
FT.
aPPrwal,
Date
225 FITTE STREET Authorrzed
SPRTNGFTELD, OREG0N 97477
INSPECTT0N REQUESTz 726-3769
OFFICE: 726-3759
1. LOCATION OF INSTALLATION
7t'1
sPtrrfutGFlELrl
spocffic land usa
EXP\RE
\ETIIF
\S
BELOg
L000 sq.ft. or less
Each additional 500sq. ft or portion
thereo f
Each Manuf,d Home. or
-
Modular Dvelling
Service or Feeder
Services or FeedersInstallation, Alterationsor ReLocation:
200 amps or less
201 amps to 400 amps
-
401 amps to 600 amps
-
601 amps to 1000 amps-Over 1000 amps/voIts
-
Reconnect 0n1y
One Circui t
Each Addi rional
ELESTRICAL PER},IIT APPLICATION
g 02qq
INY 1800 AY
OB sidential-Single or
PERTH}ji":Till,5EL o"u,,tng uni t .
Items Cost Sum
Permits are non-transferable and expireif vork is not started vithin 1B0 daysof issuance or if r,rork is suspended ior
1.80 days.
2. COMRACTOR INSTALI..ATTON ONLY
Electrical Contractor
OB
rcg t bftn
Address
ci tY_- Phone
Supervi-sor License Number
Expiration Date
Constr Contr. Number
Expil'ation Date
Signature of Supervising Electrician
Ovners Name
Address 'Z 'Vt
Ci ty
Temporary Services or FeedersInstallation, Alteration or Relocation
200 amps"or less $ 40.00201 amps to 400 amps
-
$ SS.OO0ver 40L to 600 amps
-
$ 80.000ver 600 amps or 1bOO-G'IT" "u" ,,B,, a[IF
Branch Circui ts : ..
Nev, Alteration or Extension per panel
$ 8s.00
$ 1s.00
$ 40.00
B
c
D
s s0.00
s 60.00
s100.00
$130.00
s300.00
s 40.00
$ 3s.00
OIINER TNSTALLATTON
The installation is being made onproperty I ovn r.rhich is n'ot-in-tJnaeafor saLe, lease or rent.
Circui t or rzi th Servicqor Feeder permi t -l S 2.OO
5pD
).00
E. Mi sceLl.aneous (Service/ f eeder not jncluded)-Each instaL 1a tionPunp or irr igationSign/0utli ne Lightjng--
00Ijmj tedniruf t ed Ene
Ene
rgy/Comm
tLv/9s-c $ 20.00
5. SUBTOTA L OF ABOVE
$ :0.00
s 40.00
$ 40,
DATfl
5Z Stat
3Z Admi
e Surchar ge
NRF.GON'OF
RECEIYED
gna ture:
TOTAL
ni.strati ve Fee
c
Phone 746: ZZay'
Permit #: q q 21v
Address: 25 Ll t n a. /stL'
Jl
Issued av, A ' lkl L//u out",q (
Statement: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Controctors 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 3A or 38
1. I own, reside in, or will reside in the completed structure
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
3.A'. 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
38. I will be my own general contractor
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
Owners about Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant)
Qtthite copy to issuing qgency permit file,
pink copy to applicant)
Notice to
(Date)
tr
SP}r-.?GFIELO
' r,.,wing prol€ct, ,J, and dooanot r@gulrg spocl,flc hnd ueo
aB sutmltted hsa th{t
'.," proval.
I a,,
o"t"*-1- tla -1225 FIFTB STREET
SPRINGFfELD, OREGON 97 4TTAuthorized
INSPECf,ION REQUESTz 726-3769
OFFICE: 726-3759
L
lt
0\
TJGAL DESCRIPTION
2
BLBCTRICAL PERHIT APPLICATION
COHPIJTE FEE SCMDULE BELOV
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:
Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home. or
Modular Dvelling
Service or Feeder
$ 8s.00
$ 1s.00
$ 40.00
Services or FeedersInstalIation, Alterations
or Relocation:
ON OF6t (
B.
r'U;C t-)
3
A
Sum
I I JOB DESCRIPT"ION
4ktu"s{ql w,f t ^q./'4
Permits are non-tYansferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. COI{TRACTOR INSTALI.,ATION ONLY
Electrical Contracto
Addr
Ci ty
ess {r ?200 amps or less
201 amps to 400 amps
-401- amps to 600 amps
-601 amps to 1000 amps-
Over 1000 amps/volts
-Reconnect Only
Pump or irrigation
Sign/0u tline Lighting-Limited Energy/ies -Z
Limi ted Energy/Comm
SUBTOTAL OF ABOVE5Z State Surcharge
3Z Administrative Fee
TOTAL
s s0.00
s 60.00
s100.0Q
s130.00
$300.00s 40.00
$ 40.00
$ ss.00
$ 80.00
see rrBrr aFE
A Phone Frtsy: L€3
i Supervisor License Number
,
Expiration Date iD -rt ?7
constr contr. Number l r.\$.f,
Expiration oarc I L- lg -'il
Signa Su ervising Electrician
Ovner Name
Address
Ci ty Phone
OITNER
C. Temporary Services or FeedersInstallation, Alteration or Relocation
200 amps"or less
201 amps to 400 amps
-Over 401 to 600 amps
-0ver 600 amps or 1000-ToT[s
D. Branch Circuits
Nev, Alteration or Extension per panel
One Circuit $ 35.00Each AdditionalCircuit or vith Serviceor Feeder permit _ $ Z.OO
E. Miscellaneous (Service/feeder not included)-Each installation
The installation is being made onproperty f ovn vhich is not intendedfor saIe, lease or rent.
Omers Signature:
*
$ 40,00
$ 40.00
$ 20.00
$ 36.00
DATE:Zc2-a
C'TY OF OFEGO'U
RECETYED
5
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sQrnature A fn oa ttrgra", 2fiAZV
7-D>
INSTAf,LAfIOI\r