HomeMy WebLinkAboutPermit Building 1992-02-070()3
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TAX LOT:
SUBDIVISION
Springfield, Oregon 97 477
LOCATION OF PRO
ASSESSORS MAP
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726'3769
Office: 726'3759
LOT: BLOCK:
JOB NUMBER-
225 Fifth Street
PHONE:
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CITY:
ADDRESS
OWNER:p. zL'
NEW --- REMODEL ADDITION DEMOLISH OTHER
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DESCRIBE WORK:
CONTRACTOR'S NAME VZ=t
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GENERAL:
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VA(\,L W f,u'PLUMBING €-wrV-Lrwu4>
It4 ECHAN ICAL:
ELECTRICAL:
PHON E
'i1 G t7
CONST.
CONTRACTOR #ADDBESS
IJ L.
A r u.U 5 UlrL-C-rf !- t {
RANGE:
* OF BDRMS:
_ OFFICE USE _
ZONING CODE:
FLOOD PLAIN
WATER HEATER:
SECONDARY HEAT:
SOUARE FOOTAGE:
OUAD AREA:
*,OF BLDGSI
CONSTR. TYPE
HEAT SOURCE:
LAND USE:
, OF UNITS
OCCY GROUP:
* OF STORIES:
To request an inspection, you must call 726-3769. This is a24hour recording. All inspections requested before 7:00 a.m. will be
made the same working day, lnspections requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
Temporary Electric Rough Mechanical - Prior to
cover.
Final Plumbing - When all
plumblng worl< is complete.
?'Final Electrical - When all
electrical work is complete.
Site lnspection - To be made
after excavation, but Prior to
setting forms.
Rough Electrical - Prior to
cover,
Understab P!umbing / Electrical /
Mechanical - Prior to cover.
Electrical Service - Must be
approved to obtain Permanent
electrical power.
Final Mechanical - When all
mechanical work is complete.
Footing - After trenches are
excavated.Fireplace - Prior to facing
materials and framing lnsP.P Final Building - When all
required inspections have been
approved and building is
completed.Masonry - Steel location, bond
beams, grouting.raming - Prior to cover.
Olher
Foundalion - After forms are
erected but prior to concrete
placement.l/Ceiling lnsulalion - Prior to
cover.
Underground Plumbing - Prior
to filling trench.- Prior to taping
MOBILE HOME INSPECTIONS
Underlloor Plumbing / Mechanical
- Prior to insulation or decking.Wood Stove - After installation
Post and Beam - Prior to floor
insulation or decl<ing.lnsert - After firePlace aPProval
and installation of unit.
Blocking and Set-Up - When all
blocking is complete.
Floor lnsulation - Prior to
decking.Curbcut & Approach - After
forms are erected but Prior to
placement of concrete.
Plumbing Connections - When
home has been connected to
water and sewer.
Sanitary Sewer - Prior to f illing
trench.Electrical Connection - When
blocking, set-up, and plumbing
inspections have beerr approved
and the home is connected to
the service panel.
Slorm Sewer - Prior to filling
trench.
Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
water Line - Prior to fllling
trench.[-l Fence - When completed
Streel Trees - When all required
trees are planted.
Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have becn installecl.over.
h Plumbing - Prior to
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Lot faces
Lot sq. ftg.
Lot coverage
Topograpl.ty
Total height
Lot Ty,
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Setbacks
PL.HSE GAR ACC
N
S
E
IS THE PROPOSED WORK IN THE
}JISTOBICAL DISTFIICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
ranted on the express condition that the said
construction shall, in all respects, conform
adopted by the City of Springfiel
Development Code, regulating the co
Plans Reviewed By Datc
By
Tlris permit is g
r revo ked at any time
er:
Plan Check
Date Paid
Receipt Nu
Rccei
e Ordinance
tion and use of
buildings, and may be suspend
of said ordinances.upon violation of any
ncluding the
VALUE
(A)
3
X $/SO. FT.
Total Value
Building Permit Fee
State Surcharglc
Total Fee
BUILDING PERMIT
ITEM SO. FT.
Main
Garage
Carport
Systems Dcveloprnent Charge is due on all uncleveloped
properties within the City limits which are being improved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
ITEM
Fixtu res
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
PLUMBING PERMIT
/5,1_b
FEE
NI
FT.
FT.
FT.
-75
(c)
ile HorpeM
Plumbing Perrnit
State Surcharge
Total Cltarlyc
Wood Stove/ lnsert/ Fireplace Unit
Dryer Vent
MECHANICAL PERMIT
(D)
No
Mechanical Permit
lssuance
State Surcharge
Total Permit
Fu rn ace
Exlraust Hood
Vent Fan
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that all
information hereon is true and correct, and I f urther certify
that any and all work performed shall be done in accordance
with the Ordinarrces of the City of Springf ield, and the Laws
of the State of Oregon pertaining to the work described
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 in compliance with ORS 701.055 will be used on this
project.
I f urther agree to ensure that all required inspections are
requested at the proper time, that each address is readable
from the street, that the permit card is located at the f ront
of the property, and the approved set of plans will remain
nz-
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Signatu
Date
on the site
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
\I
DATE PAID
AMOUNT RECEI
RECEIVED BY
VALIDATION:
RECEIPT NUMBER
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
I
I-TC'TY OF
I
Constr Contr.' Number
225 FIFTE STRBEf,
SPRINGFIELD, OREGON
INSPBCf,ION REQTIBST:
OFPICE: 726-3759
1.
JOB O
Permits are non-transferable and expirelf vork is not started vithin 180 daysof issuance or if vork is suspended for
180 days.
2. COMRACTOR INSTALI.ATION ONLY
Electrical Contractor
Address
Ci ty Phone
Supervisor L cense Number
Expiration Date
sla.t rtr{(;I: aLLL)
SCEEDULE BELOU
Nev Residential-Single or
MuIti-Family per dvelling unit.
Service fncluded:
Items Cost
1000 sq.ft. or }ess
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
$ 8s.00
$ 1s.00
s 40.00
Services or Feeders
Installation, Alterations or
Relocation:
Ai!
ELECTRICAL PERHIT APPLICATIoN.,,s.,
city Job Number qeDI\z)
Sum
B.
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps _601 amps to 1000 amps_
Over 1000 amps/volts
Reconnect 0nly
$ s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
Expiration Date
1 gnat of ing Electrician(a
Ovners Name
Address
Ci ty Phone
OIJNER TION
The installation is being made on
property I ovn vhich is not intended
for sale, Iease or rent.
0vners Signature:
DATE:
RECEI
Temporary Services or Feeders
InstalLation, Alteration or Relocation
200 amps or less $ 40.00
0ver 40L to 600 amps _ S 80.00
0ver 600 amps or 1000 volts see "8" abo'/e
Branch Circuits
Nev, Alteration or Extension Per Panel
,J
4 Ab qb.'
C
IOneCircuit I S35.00
Each Addi. t ional
Circuit or vith Servicg,
or Feeder Permit .-3 S 2.00
.5e
IE
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/outline Light ing-
Limi ted Energy/Res
Limited Energy/Comm
SI,ETOTAL OF ABOVE
5Z State Surcharge
TOTAL
40.00
40.00
20.00
36.Q0d)
s
$
s
s
RECEIVED BY:
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FIRE DAI,IAGE REPOP.T
OR
ELECTRiCAL IiAZARD
DATE: l-30- q?--
TO:
FR0l"l:
SUB.-IECT:
Bu i 'l d'i ng Depa rt-'ren t
Springfield Fire Deparunent
Structural Damage to Bu'i1cii ng
Address or'location of build'ing i 31L l/.)-L
Name cf or.iner
Type of bu'ilding
(Dwelling, S tore,Warehouse, etc. )
Estimated va'lue of bui I di nq
Estimated loss to buildinq
s 3o,.tuc
pcr O
Date of fire t- 30- g7
Location of damage in building tYlasle.,u b<l Dw?
Structural weakness as a resu'lt ci the f ire t
(Surned r:f :ers, 3ean-'s, .ro js:s, etc. )
Addj t'ional per't'inent jnfcrmation
af'2
i iancri
t)
l- L"-/"4
/4/<
/,1-,---,L,1.L
5eJElectrical Hazard t
(t,iirinq, Cutlets, etc. )
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