HomeMy WebLinkAboutPermit Miscellaneous 1997-9-12
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RESIDENTIAL
PERMIT APPLICATION
!nspectlons: 726.3769
Office: 726.3759
97/S(4
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JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
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LOCATION OF PROPOSED WORK:
ASSESSORS MAP' ) 70 2.-
LOT'
O/'2..~
TAX LOT:
SUBDIVISION'
BLOCI<"
OWNER: .:-,() r. '" j [,. e Id
ADDREe",. ,1)<:"0 /IJ.
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PHONE: /}:J(,., ::J. ':i9e--
crJ 1/ '7'7
Or
CITY:
STATF'
ZIP:
,-/)S7;?C:;//<;d
/PC:l/~{l~
DEMOLISH L
DESCRIBE WORK'
NEW
REMODEL
ADDITION
OTHER
CONST.
ADDRESS' <Ii- CONTRACTOR ·
~-< RiVO,,-L~ J f(/rlJ,. ":nU-3
CONTRACTOR'S NAMh
GENERAL: fr;cT' QI YA,/..:J $'.
I '
EXPIRES
S.~
..... PHONE
.. ?,K!- 7c><:~
PLUMBING'
MECHANICAl'
ELECTRICAl'
- OFFICE USE - i"'~ \NO~"
LAND US'"^.,.\c~: . 'l,.'- ~'I."\~~\~ow.\'tl~~~\LAIN'
~. w.\ibl'\I" ",\S""-" p-
· OF UNIJ:Sn"- \lE.~ . \\\r!:'p. i O~~~ING CODE:
ID'- "'ll~Uv B",~t)
CONSTR. T~O ':P IS '" . OF BDRMS:
I" ~~C\:.U \)
HEAT SOU_"^ " ?I"-'P,IO .
eO\)t'\
RANGE: -':"IloN~ ,
QUAD AREA'
. OF BLDGS:
OCCY GROUP:
. OF STORIES:
WATER HEATER:
SECONDARY HEAT:
SQUARE FOOTAGE:
To request an Inspection, you must call 726-3769..Thls Is a 24 hour recording. All Inspections requesled 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.
REQUIRED INSPECTIONS
D Temporary Electric
D Rough Mechanical -.: Prior to
cover.
D Final Plumbing - When all
plumbing w9rk Is complele.
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Rough Electrlcsl - Prior to
cover.
D Final Electrical - When all
electrical work Is complete.
D Underslab Plumblng/Electrlcal/
Mechanical - Prior to cover.
D Final Mechanical - When all
mechanical work Is complete.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D FooUng - After trenches are
excavated.
w('Flnal Building - When all
~equlred Inspections have been
approved and building Is
completed.
D Flreplece - Prior to facing
materials and framing lnsp..
D Masonry - Steel location, bond
beams, grouting.
D Framing - Prior to cover.
DOther
D Foundation - After forms are
erected but prior to concrete
placement.
D Wail/Ceiling Insuletlon - Prior to
cover.
D Underground Plumbing - Prior
to filling trench.
D Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Wood Stova - After Installation.
D Blocking snd Sat.Up - When all
blocking Is complete.
D Post and 8eam - Prior to floor
Insulation or decking.
D Insert - After fireplace approvel
and Installation of unit.
D Floor Insulation - Prior to
decking.
D Plumbing Connections - When
home has been connected to
water and sewer.
D Curbcut & Approach - After
forms are erected but prior to
placement of concreto.
D Sanitary Sewar - Prior to filling
trench.
D Electrical Connection - When'
blocking, set.up, and plumbing.
Inspections have been approved
and the home Is connected to
the service panel.
D Sidewalk & Driveway - After
excavation Is complete, forms
and sub.base material In place.
D Storm Sewer - Prior to filling
trench.
D Water Line - Prior to filling
trench. ,
D Fence - When completed.
D Final - After ell required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed,
D Rough Plumbing - Prior to
cover.
D Street Trees - When all required
trees are planted.
. ,
L~I ~ype. ',.?
',\
Lot faces
Lot sq. ftg. . Interior
Lot coverage Corner
Panhandle "
Topography
Total height Cul.de.sac
.'
:i
BUILDING PERMIT
ITEM SQ. FT.
if "1:
X $/SQ. FT. D
Main
Garage
Carport
Total Value
Building Permit Fee
Slate Surcharge
TOlal Fee
(A)
'{ ..f :' . ~~',;,,:.:ti;! '1 :~: .v' ~'~.~Nr.~ \' ....
I P.L.
IN
Is
Iw
IE
VALUE
"
(B)
SYSTEMS DEVELOflMENT CHARGE (SDC)
PLUMBING PERMIT.", ,
ITEM ..~ ,j .,' Hr, ',.
I,. "1, 1l
...,', ',. ;j
Fixtures ',' .
N' ,
Residential Balh(s)
Sanitary S~wer FT.
Water FT.
Storm Sewer FT.
Mobile Home
-lI'
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
N'
Wood Stovellnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
1'10 r- I)f
State Surcharge
Tolal Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
. Ii
/ f/-, '?tJ
l/t-1-
Ji. f4-
n.#!-
Setbacks,
HSE GAR ACC'
'.
( IS THE PROPOSED WORK IN THE.
--'HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
II yes, lhls application must be signed'
and approved by the Historical
Coordinator prior to permit Issuance.
I
I
I I APPROVEn.
BUILDIt.J!G V~L1jE. 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
bulldl ngs, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plan Check Fee'
Date Paid:
Receipt Number:
Received By:
Plans Reviewed By
Date
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
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By slgnature,l state and agree, that I have carefully examined
the completed application and do hereby certify that all
Informatlon hereon Is true and correct, and I further certify
that any and all work performed shall be done In accordance
with. the Ordlnencus of the City of Springfield, and the Laws
of the State of Oregon perlalnlng to tho work described
herein, and that NO OCCUPANCY will be made of any
structure without permission of lhe 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 further agree to ensure that all required Inspections are
requested at the proper time, lhat each address Is readable
from the street, that the pormlt card Is located at the front
of the property, an e approved set of plans II remain
/
on the site at al mes during construct on.
~atu r7 .~- 0
Dat". . ")'-/2 -1; v
VALIDATION:
RECEIPT NUMBER
DATE PAir"
AMOUNT RECEIVED
RECEIVED BY
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