HomeMy WebLinkAboutPermit Mechanical 1999-7-9
RESIDENTIAL
PERMIT APPLICATION
.
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK: \.Q..\ \ \)
ASSESSORS MAP' /70 ~ ZJ 3 ~
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OESCRIBE WORK' \'\'\~\~~ ~ \~. C\"'~\-\\'\'("\\). ('J:l,
NEW REMODEL ADDITION 4-- DEMOLISH
LOT'
OWNER'
CITY'
CONTRACTOR'S NAME
GENERAl'
PLUMBING'
MECHANICAL: '\\()~ 0
BLOCK:
STATE:
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OTHER
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JOB NUMBER -'tic -;;0
225 Fifth Street. 91 0 Cj ;;(.c,
Springfield, Oregon 97477 . I
.
TAX LOT: // OCe> ~
SUBDIVISION: ~-r
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ZIP:
CVI L\ '11
ADDRESS
CONST.
CONTRACTOR'
EXPIRES '.-:'> PHONE
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ELECTRICA' '
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31..\5-:;).,&58.
- OFFICE USE -
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QUAD AREA- 1 w leQ.I.!AND USE:\" FLOOD PLAIN'
'Olegoll a oregon u".. ,
· OF BLDGS: ..,-n::NI10N. -'-.-ib~ t\"16 . OF.tUNI:rSlrtl1 ZONING CODE: .
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OCCY GROUP: \ol\OW r~.. """tel. ~~S OUgtC0r.fs~~, \U'(,ftiSj --"M)11C, LLc:vpmHlfB1i1IIMMORK
Not\tlG,,""U" 001-0010\ I . <:.o\\l1elu " ISPERMITSHII: ~ I~Nm
. OF STORIES'rr"OI'l95Z- J=taincO\lle'HEATI@OI'iRCE: 11-1 CNDER\Hlg~?'f-{EAT:
I Co '(ourn<:lY~~'- ~Note'.trl~~~ ilication AlffiIORIL.I:.UU' ^MnnNI"OFOR
WATER HEATEil09 '.. - 'Jo" roentel: gon llti8!;\N&~: _ ..- '3E8-GR IS ABISt!lW'.flrFOOTAG E:
call'"'' ~__t"'eore _ _n".?::\44). COM\VI~"v_._~
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To request an Inspection, you,lftust call 726.3769. Thts Is a 24 houAN;CClf(!frlll. 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,
o Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
settIng forms.
o Underslab Plumbing/Electrical I
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting,
o Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
o Underfloor Plumblng/Mechanicel
- Prior to Insulation or decking.
o Post and 8eam - Prior to floor
Insulation or decking.
o Floor Insulation - Prior to
decking.
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench,
o Water Line - Prior to filling
trench. . .
o Rough Plumbln~ - Prior to
cover. .
REQUIRED INSPECTIONS
o Rough Mechanical - PrIor to
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.
o Framing - Prior to cover.
o Wail/Ceiling Insulatlo~ - Prior to
cover. ,
o Drywall - Prior to. taping. .
o Wood Stovo - After installation.
o Insert - After fireplace approval
and Installation or unit.
o Curbcllt & Approach - After
forms are emcted but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material in place.
o Fence - '/Vhen completed.
D Street Trees - When all required
trees are planted.
o Flnel Plumbing - When all
plumbing wc;>rl< Is complet.e.
~:::-:;,
fnal Electrical - When all
electrical work.ls complete.
ceCl
Final Mechanical - When all
D mechanical work Is complete.
C LJ Fhlal Building - When all
- ......requlred Inspections have been
, approved and building Is
completed.
o Other
MOBilE HOME INSPECTIONS
o Blocking and Set.Up - When all
blocking Is complete,
o Plumbing Connections - When
home has been connected to
water and sewer.
o Electrical Connection - When
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
Lot ~ype"
Lot SQ. ltg,
Interior
Lot coverage
Corner
Panhandle 'f'
Topography
Total height
Cul.de.sac
BUILDING PERMIT!;
'j; 't
ITEM
SQ, FT.
X $/SQ, FT, ~
Main
Garage
Carport
Total Value
Building Permit Fee
Stale Surcharge
Total Fee
(A)
I PL.
IN
Is
W
----
E
VALUE
"
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBIN.G PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary S~wer
Water
FT.
FT.
FT.
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/Insert/ Fireplace Unit
Dr;;;t
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
Tolal Miscellaneous Permits (E)
TOTAL AMOUNT ~UE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
_luo
;(:() (;
II>' (1':>
/.5-D
't-t.n
.' ,,",,'.;';.\;:':.,
'~S THE PROPOSED WORK tN THE.
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
..;
Setbacks
HSE GAR Acc'l
I
I
APPROVED:
" .''ro . "~ "
BUILDING VALLIE, 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 tho City ot Springfield, including the
Development Code, regulating the construction and use of
oulldings, 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
4
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I
--
By signature, I state and agree, that I have ca.refully examined
the completed application and do hereby certify that all
Information hereon Is true and correct, and I further certify
that any and all work performed shall be done In accordance
with the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be made of any
structure wllhout permission of the Building Safety Division.
I further certify that only contractors and employees who
are In compilance 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
:~g:::u:~e//;?du:~ '~~;e& ).
v-C- ~ - - '------r .....----
Date 7-' q g.. --
~ .'
VALIDATION:
RECEIPT NUMBER {J ~ ~ 77 f
DATE PAID 7/0 (flf ~
. ;j 2-'.5?;;l
cY tJ~
AMOUNT RECEIVE'"
RECEIVED BY