HomeMy WebLinkAboutPermit Building 1992-12-11RESID ENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
SP RI,tGFIELO LI
h,
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97 477
It r+5a or rs 4+
ASSESSOBS MAP:11 0 TAX LOT:ool
BLOCK:SUBDIVISION:
-
must call 726-3769- Thls ls a 24 hour recording. All lnspectlons requested before 7:00 a.m. will belnspections requested after 7:00 a.m. wilr be made the foilowing work day.
REQUIRED INSPECTIONS
LOT:
tl
g
To request an inspection, you
made the same working day,
l---l temporary Elecrric F
Site lnspeclion - To be made
after excavation, but prior to
setting forms.
Underslab Plumbing/ Eleclrical/
Mechanical - Prior to cover.
Footlng - After trenches are
excavated.
Masonry - Steel locatlon, bond
beams, groutlng.
Foundallon - After forms are
erected but prior to concrete
placement.
Underground Plumbing - prior
to filling trench.
Underlloor Plumblng / Mechanical
- Prior to insulation or decking.
Post and Beam - Prior to floor
insulation or decking.
Rough Mechanlcat - prior to
cover.
Rough Electrical - Prior to
cover.
Eleclrical Service - Must be
approved to obtain permanent
electrical power.
Flna! Plumbing - When allplumbing work is complete.
Final Electrical - When allelectrical work is complete.
Final Mechanical - When allmechanical work ls complete.
tr
B
tr
XFlreplace - Prlor to faclng
materlals and framlng lnsp.
X framing - prlor to cover.
,XDrYwall - Prior to taping
Wall/Ceiling lnsulation - prior to
cover.
Final Building - When ailrequlred inspections have beenapproved and building iscompleted.
MOBILE HOME TNSPE TIONS
l-l Btocking and Ser.Up - When ail
-
blocklng ls complete.
Plumbing Connections - Whenhome has been connected towater and sewer.
Eleclrical Connection - Whenblocking, set-up, and plumbing
lnspections have been approved
and the home is connected to
the servlce panel.
Final - After all requiredinspectlgns are approved andporches, skirtlng, decks, and
venting have been installed.
l--l water Llne - Prior to fltting
'J trench.I--l Fence - When compteted.
Floor lnsulation - Prior to
decking.
Sanitary Sewer - Prior to fiiling
trench.
Storm Sewer - Prlor to filling
trench.
ffi Curbcut & Approach - Afterts forms are erected but prior toplacement of concrete.
tr
Wood Stove - After installation.
lnsert - After fireplace approvaland installatlon of unit.
Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
Slreot Trees - When all requlred
trees are planted.
PHONE:
OR q7y7&
ZIP:STATE:
bYo7'ab-1OWNER:T?uus
ADDRESS:
' ESo 5,
CITY:S Ft
ta 3rJ
td
NEW- REMoDEL ADDrroN DEMoLTsH orHER Rglt*C]
R p-4D11F <.pDESCRIBE WORK:
PHONE
5E b
CONTRACTOR'S NAME
MECHANICAL:
ELECTFIICAL:
ADDRESS EXPIRES
CONST.
CONTFIACTOR #
GENERAL:
PLUMBING
WATER HEATEFI
ZONING CODE:
FLOOD PLAIN
RANGE:
QUAD AI]EA:
* OF BLDGS:
SECONDARY HEAT
SQUARE FOOTAGE:
# OF BDRMS: _CONSTR. TYPE:
HEAT SOURCE:
OCCY GROUP:
* OF STORIES:
E Rough Plumbing - Prior to
cover.
- OFFICE USE _
LAND USE:
# OF UhllTS: _
E
[-_l othertt
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Setbacks
P.L.HSE GAR ACC
N
S
E
1S THE PROPOSED WOFIK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this application must be signed
and approved by the Historlcal
Coordinator prior to permit issuance.
APPROVED
VALUE
S,oce,&
.5C^,co
;?, s3
(A)
x $/so. FT.
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carport
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of Springfield, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plans Beviewed By Date
Receipt Numbe
Plan Check Fee
Date Paid
Received By:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ITEM
Fixtu res
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
b_ Zo,c;D
FEE
FT.
25,oDFT. 5O
.<5,6D
No
,;€a ffi
(c)
PLUMBING PERMIT
Plumblng Permlt
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Fireplace Unit
Dryer Vent
l,r: a
/orcfr
,1r
(D)
rtlt il, Fee
Vent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Furnace
Exhaust Hood
Nol
By signature, I state and agree, that I have carefully examlned
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 Ordinances 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 perrnission of the Building Safety Division.
I further certify that only contractors and employees who
are in compliance with ORS 701.O55 will be used on this
proicct.
I further agree to ensure that all required lnspections are
requested at the proper time, that each address is readable
from the street, that the permit card ls located at the front
Signatu
Date
a
te at al mes during
the approved set of plans will remainY,of tlre
ructionont
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
l2,1tt
lz,1aTotal Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, q D, and E Combined)
@c@
LLh L, q2-
aD
RECEIVED BY
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT R
vao RE9IDENT]AL - COMIItrRCIAL
gIDEII,ALK / CURtsCUT
APPLICATIOT.I / PEFfiIT
SPFIINGFIELO
225 NORTI{ FIFTI{ gTREEI
sPRlhl3FtELD, ORE60hl 31411
Er.l6tNEER[.l3 D tVtItOt l
oFFlcE No. 126-A1b)
IN9PECTION LINEr'126-3'169
JoB ADDRESO,
A99E99OR9 HAT NO.,'7
9JBDlvlSlohl:
s.v .cl
LOT NO.
OIINER:
ADDRE99: 2 o
sTATE, t9 f
C-.
vd-clrY,5 rrtl
ztP, 7> Vz *,Pr{ohrE No. /LL.\t 6 |
IIJOFK DESCRIPTION:
IIJoFK TO DE PEFFOFT'IED EY:Otll.lER COI.ITRACTOR
9lDElLlALK: cURts 9lDE
-
9ETBACK _
CURB-CtlTr 1 RESIDENTIAL )< coF4HERtcAL
-
9ECOhID DRI\EIUAY ( 5EE TRAFFIC )
REAUIRE9 APPLICATIOT.I FOR A 9ECOND DRI\€IU,AY(T-4.IA,)
OR A COTJNTY APTLICATIOhI FOR FACILITY FERI1IT (C AA.2O3)
IF IN TI{E U6E.
DATE OF APPLlCATlol.l
RECEIPI NOz .z
cAeH x
CI{ECK
CI{ECKED FOR DELNAU*"'='* Y
9t6hlED;
DATE,4-<-
?**
ADDRESS 0
I Ir
PROCEDUFE FoR INgPEcTIoN RE@tlE6Tr
*gEE BOOK
CALL 12b.9169 (RECORDER ) STATE YOUR CITY DE9IGNATED JOB NUFIBER, JOB ADDRE99,TYPE OF
INgPECTIC'I.I REAUEgTED AlD II}.{EN YOU IUILL BE READY FOR IN9PECTIOI.I. COhITRACTORS OE OtlhrCES NAFE A}.ID
P+-IONE NI}1BER REAUEgTg RECEI\GD BEFORE NOO Nl IUILL BE IIADE TI{E 5A1E DAY, REAUESTS /fIER \ZOO
A}.1IUILL BE I1ADE TI{E NEXT II,I2RKIIG DAY
qabq"(
EXI9TII.IG
REGISTrITTION NO.
IT NO. ( IF
EXPIRE9'
etao{E,77 l2
gIDEIUALK / DRI\/EIUAY
FOR ALL CONCRETE PAVING IIJITHN
THE STREET RIGHT OF IiJAY, TO BE
I1ADE AFTER AL EXCAVATIN6
19 COHPLETE AlD FORTI IIJOFK
AID S,I,JB-BA'SE F1ATERIAL 19
IN PLACE
c,U@ / APFROACI{ APROif&
AFTER FOFHg ARE ERECTED
BUT PRIOR TO POURII.IG
CONCRETE.
FEE6' glDELlJALKg cuRB-CUT IUALK X,tlo.@o + !O.|>/LF.( X )
OF LUALK
.{'
TOTAL PEFI'i|T FEE,I IZ-1U
tlO.O@+t@.lb/LF.(X)
COI-IIIERICAL DRI\GIUAYg gI{ALL
HA\G 5' TO A'FLAIRg
3,. @tr STAIDARD
I I{A\€ CAREFULLY EXAI-1INED TI-.IE COF1PLETED APPLICATIOhI FOR FERfiIT, A}{D DO I-]EREBY CERTIFY TI{AT ALLNFORTATIOhI I.{EREON 15 TRTIE AND CORRECT, AT.ID I R]RTI{ER CERTIFY THAT ANY Al.{D ALL uJc)RK PEFFORTIED9HALL BE DONE lN AccoRDANcE tlJlrH THE oRDlNAl.lcEg oF THi ctry oF gpRtNGFtELD, alD THE LAuIS oF Tr{ESTATE OF OREGON PERTAININ6 TO TI]E UJOFK DESCRIBED UENEIN, AND TI..IAT NO OCCUPANCY IUILL BE F1ADEoF AhlY srRLlcTuRE ulrt-lour PERHlgglohl oF THE ButLDrr.rc DrvtgroN. I FuRTI{ER ceiirrr rFrAT oNLy coNTRAcroRgAID EI1PLOYEE9 [T+{O ARE IN COT,IPLIANCE IUITH OR' IOIO>> UJILL BE USED ON TI-.II9 PRC)JEC,T,
DATE
v-s -?3
i
Oo " i)o-u /2 o
4-s -'tz
h ^a >.9?
REaUIFED INgFEcTlol.lg
C'TY OF
sPrilt{Grrt:LO
-i %
225 FTFTA STREET
SPRINGFTELD, OREGON 97 477
INSPBCTION REQTIEST:
0FPICE: 726-3759
726_176e [.-t]l-- 't -
ELECIR.ICAL PERHIT APPLTCATION
City Job Number
COHPIJTE FEE SCEEDULE BELOII
Nev Residential-Single or
Hulti-Family per dvelling unit.
Service Included:
Items Cost
1000 sq.ft. or less
Eaeh additional 500
sq. ft or portion
thereo f
Eaeh Manuf'd Home or
Modular DveIling
Service or Feeder
$ 85.00
$ 15.00
s 40.00
Services or Feeders
Insta1lation, Alterations or
Relocation:
Authorized Signatur,
1. .LOCATION OT INSTALI.ATIONld :*, 'l'/.A.
l7o >3
'. C."a
I
Sum
K 6i^)l
JOB DESCRIPTION@:.
Permits are non-transferable and expireif vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. COIIIBACf,OR INSTALI.ATION OM,Y B
B,-,* t.,Electrical Contraetor LtJ
Address N
Ci ty FJI (,Phone @.41 +4
Supervisor License Nrimber 3d{rA-S
Expiration Date I -tO -t {
constr contr. Number 6 .S 8,i 5-
Exp iration Date {-tt'?Z
Signature of lng trician
c Temporary Services or Feeders
Installation, Alteration or Reloeation
D. Braneh Circuits
Nev, Alteration or Extension Per Panel
OnE Circui t s 3s.00
Each Additional
Circuit or vith Service
or Feeder Permi I /D $
200 amps or less $ 40.00
201 amps to 400 amps _ $ 55.00
0ver 401 to 600 amps _ $ 80.00
0ver 600 amps or 1000 volts see "B" above
200 amps or less y
201 amps to 400 amps
-401 amps to 600 amps _
601 amps to 1000 amps_
0ver 1000 arnps./vo1ts
Reconnect Only .
SUBTOTAL OF ABOVE
5f, State Surcharge
TOTAL
t4 $ s0.00
$ 60.00
$100.00
$130.00
s300.00
$ 40.00
@
rs Name Srult- filu
'>ED ), 43"/Address
Ci ty Phone 1>U,qU/ A
OVNER INSTALI,ATION
The installation is being made on
property I ovn vhich is not intended
for sale, Iease or rent.
Ovners Signature:
DATE:
RECEIPT
E. Hiscellaneous (Service/feeder not included)
-Each installation
Prrmp or irrigation
Sign/outline Lighting-
Limi ted Energy/Res
Limi ted Energy/Comm
ae.43,eW
2.oo JCI€
$ 40.00
$ 40.00
s 20.00
s 36.00
RECEIVED BY:
'90'q3 5