HomeMy WebLinkAboutPermit Miscellaneous 1992-7-1
, '.
.
.
Permit No:
92D '3/ r
Address: /97.:l /#c. ~S~ ~;-;
Issued bY:,{f}~ Date: ]~~2....
;
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state.
ment is required for residential building, electrical, mechanical, and plumbing
permits. Licensed Architect and Engineer applicants, exempt from registration
under ORS 701.010(7), need not submit this statement. This statement will be
filed with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1.,1 ~ I own, reside in, or will reside in the completed structure.
2, ,I =::>-<::1 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. I I My general contractor if'
Contractor registration number
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3, B..:r--><'t.,.! will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If 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 Information Is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
cAli ~:I! ~
~Of Permit Applicant
7-/ -92-
, Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
L. 7c1--6hd
ADDRESS: 1973 #r '7/:JUI S t,
CITy:,~fJ drJ}
? U-J,.:.I j"
.~.
.
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726,3769
Office: 726,3759
LOCATION OF PROPOSED WORK: _/97'3
/7/'71. ?_ 7 J 2,
ASSESSORS MAP'
LOT:
OWNER: A/J/u//,U
DESCRII3E WORK:
NEW _..rX..__ REMODEL
ADDITION
CONTRACTOH'S NAME
GENEflAL: _ .-t!J(, 1A"Fr?.
PLUMBING:
MECHANICAL:
ELECTRICA' '
OUAD AREA-
. OF BLDGS'
OCCY GROUP:
. OF STORIES:
WATER HEATER'
.
. ;t~:!~ 5
JOB NUMBER...:::,-. - . .- $-
225 Fifth Street
Springfield, Oregon 97477
lj
TAX LOT:
SUBDIVISION'
1"?~9t90
SPRINGFIELD
/.It' 7h Ii / <;/..
BLOCt<.
{f,+,
STATE:
rnl?
PHONE:.-2..2 {,.
-7 Jt?r/
7)l"'rj(
<t
h:".I~L
ZIP:
C} 7 c(L7
, ~
~
~'\
DEMOLISH
OTHER
EXPIRES
PHONE
ADDRESS
,CONST,
CONTRACTOR'
FLOOD PLAIN:
ZONING CODE:
. OF BDRMS:
SECONDARY HEAT:
SOUARE FOOTAGE:
To request an inspection, you must call 726.3769. This Is a 24 hour recording. All Inspections requested before 7;00 a.m. will be
made the same working day, Inspections requested after 7:00 a.m. will be made the following work day.
CI TcmporalY Elochlc
o Site Inspection - To be made
aller excavation, but prior to
selling forms.
o Undcrslab Plumbing/ElectricalJ
Mechanical - Prior to cover.
~ Footing - After trenches are
~xcavatcd.
o Masonry - Steel location, bond
beams, grouting.
o
Foundation - Aftor forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
o Underlloor Plumbing/Mechanical
_ Prior to Insulation or decking.
o Post and Beam - Prior to floor
insulation or decking.
o
Floor Insulation - Prior to
deckin{J.
o
Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench.
o Water Line - Prior to filling
trenell. ,
o Rough Plumbing - Prior to
cover.
- OFFl~"'U~
LAND USE: \ \~
. OF UNITS'
CONSTR, TYPE:
HEAT SOURCE:
RANGE:
REQUIRED INSPECTIONS
o Rough Mechanical - Prlor.lo
cover.
o Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrIcal power.
o Fireplace - Prior to facing
materials and framing Insp.
%"Framlng - Prior 10 cover,
o Wail/Ceiling Insulallon - Prior to
cover.
o Drywall - Prior to taping.
o Wood Stove - After Installation.
o Insert - After fireplace approval
and Installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub.base material In place.
o Fe:nce - When completed.
o Street Trees - When all required
trees are planted.
o
Final Plumbing - Wilen all
plumbing work is complete.
o Final Electrical - When all
electrical work is complete.
o Final Mechanical - When all
mechanical work Is complete.
B Final Building - Wilen all
required Inspections have been
approved and building'is
completed.
o Other
MOBILE HOME INSPECTIONS
o Blocking and Sel.Up - When all
blocking Is complete.
o Plumbing Connections - Wilen
home has been connected to
water and sewer.
o Electrical Connection - Wtlen.
blocking, set.up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
o
Final - After all required.
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
Lot faces
LOI Type.
Lot sQ. fig,
Interior
Lot coverage
Corner
Topography
Total height
Panhandle
Cul.de-sac
BUILDING PERMIT
ITEM SQ, FT, X $/SO, FT.
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) NO
Sanitary Sewer FT.
Water
FT,
Storm Sewer
FT,
Mobile Home
Plumbing Permit
State Surcharge
Tolal Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood StovcJlnscrtlFlreplace Unit
Dryer Vent
Mechanical Permit
Issuance
Stale Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
Stale Surcharge
PiA,,] ~n.J
Tolal Mlscollaneous Permits (E)
TOTAL AMOUNT DUE (oxcludlng eleclrlcal)
(A. B. C. D. and E Combined)
.-'
,
. THE PROPOSED WORK IN THE
lISTORICAL DISTRICT. OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by ttw Historlc;)1
Coordinator prior to permit Issuance.
SOlb,cks
I PL, I HSE GAR I ACC
IN
Is
\W I
L_-~
VALUE
FEE
C), 7">
25.~P
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition thilt the said
constructIon shall, in all respects, conform to tile Ordinance
adopted by the City 01 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.
Plan Check Fee: _9. 75
Date Paid:
Receipt Number:
Received By:
.r/~
Plans Reviewed By
~~2
~~
) 6,CO
7~
/ s: 7.S'
SYSTEMS DEVELOPMENT CHARGE (SDC)
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
By signature, I state and agree, that I have carefully examined
the completed application and do hereby cel'llfy 111<11 all
Information hereon is true ilnd correcl, and I further certify
that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield. and tile Lilws
of the State of Oregon pertaining to the wOlk described
herein, and that NO OCCUPANCY will be Illade of any
structure without permission 01 the Building S;llely Division.
I further certify that only contractors and employees who
are In compliance with ORS 701.055 will be used on this
project..
I further 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 front
of the property, and the approved set of plans will remain
on the slle at all limos dUringffnstru~t?& /J
'x:::lgnatu~/J'~J' _I G3 ~
/
Dalp 7-/- 92.......
VALIDATION:
RECEIPT NUMBER 5-12.S
DATE PAID ~LI..72..
AMOUNT RECEIVED 25,. so
~
RECEIVED BY