HomeMy WebLinkAboutPermit Miscellaneous 1995-4-10
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726-3759
LOCATION OF PROPOSED WORK'
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ASSESSORS MAP:
LOT-
.
SPRINGFIELD
BLOCK'
,\W:~kq~~,
~ f\ 0 10 ) \ 1) ~ .v'N\J. -l<b
CITY:
OESCRIBE WORK'
NEW
REMODEL
CONTRACTOR'S NAME
GENERAl'
PLUMBING:
MECHANICAl'
ELECTRICAl'
~~Ye~
QUAD AREA:
. OF BLDGS'
OCCY GROUP'
. OF STORIES'
WATER HEATER:
.
940/27
JOB NUMBER
225 Filth Slreet
Springfield. Oregon 97477
TAX LOT:
SUBDIVISION'
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PHON'"
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REQUIRED INSPECTIONS
~ Rough MechanIcal - Prior to
cover.
o Rough Electrical - Prior to
cover.
o Electrical Service - Musl be
approved to obtai n permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
Ik3 Framing - Prior to cover.
~all'Celllng Insulation - Prior to
cover.
~ryWall - Prior to taping.
o Wood Stovo - After Installation.
o Insert - After fireplace approval
and Installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placemont of concrete.
o Sidewalk & Driveway - After
excavation Is compiete, forms
and sub.base material In place.
o Fence - When completed.
o Street Trees - When all requIred
trees are planted.
ZIP:
lfl1JP>
ADDRESS
CONST.
CONTRACTOR'
PHONE
EXPIRES
~
;.
FLOOO PLAIN'
ZONING CODE:_
. OF BDRMS:
SECONDARY HEAT:
SQUARE 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.
ADDITION
DEMOLISH
OTHER
o Temporary Electric
D Site Inspection - To be made
after excavation, but prIor to
setting forms.
o Underslab Plumbing/Electrical!
Mechanical - Prior to cover.
o Fooling - 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 Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
r--:Ypost and Beam - Prior to floor
~ insulation or decking.
~Ioor Insulation -. Prior to
u.::J decking.
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench.
O Waler Line - Prior to filling
trench.
tJf Rough Plumbing - Prior to
cover.
- OFFICE USE -
11\1
LAND USE:
. OF UNITS' ,
CONSTA. TYPE: ---'!:i,Ai
HEAT SOURCE:
RANGF'
~Inal Plumbing - When all
plumbing w<;:>rk is complete.
D Final Electrical - When all
electrical work is complete.
m Final Mechanical - When all
mechanical work Is complete.
~Inal Building - When all
required Inspections have been
approved and building Is
completed.
DOthor.
MOBILE HOME INSPECTIONS
o Blocking and Sel-Up - When all
blocking Is complete.
D PJumbtng 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
Ins"pectlons are approved and
porches, skIrting, decks, and
venting have been installed.
";",' .'~. ,:"I'~)
Lol Type ' "tt ~ _IS THE PROPOSED WORK IN THE.
Lot faces Setbacks
Lot sq. IIg. Interior I PL. HSE GAR Acc'l HISTORICAL DISTRICT, OR ON
- IN I THE HISTORICAL REGISTER?
Lot coverage Corner If yes, Ihls application must be signed
Is I and approved by the Historical
Topography Panhandle Iw I Coordinator prior to permit Issuance.
Total height Cul-de-sac IE I
APPROVED:
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT. = VALUE
Main
Garage
"
Carport
Total Value
Building Permit Fee ~d ~7, 2-r
Slale Surcharge '2-,1(<>+ ;,1B 3~' 6.L~
Total Fee (A)53.\~;~.':::.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
,.,
'--'"
PLUMBING PERMIT
ITEM
FEE
Fixtures
Resldenllal Bath(s) N'
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
Mobile Home
Plumbing Permit ~Cu.J~
Slate Surcharge /.:L r -r .? S-
Total Charge (C)
-z.c;o -::>
2- ;'''''
'2.:7. " "
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood StovellnsertlFlreplace Unit
Dryer Vent
Mechanical Permit .A"8i:J~
7,)0
;0,00
.~I
/rs./I
Issuance
Stale Surcharge ,3 to -1- ,2..:>
Total Permll (D)
MISCELL/\NEOUS PERMITS
Mobile ,Home
State Issuance
State Surcharge
Sidewalk
II
Curbcul
II
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
/ /J/J. 7(,
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permllls granted on the express condlllon that the said
construction shall, In all respects,'conform 10 the Ordinance
adopted by the City, of Springfield, Including the
Developmenl Code, regulating the conslructlon and use of
buildings, 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
By signature, I stalo and agree, that I have carefully 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 Ihat 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 further agree to ensure that all required Inspections are
requested allhe 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 site at all times during construction.
~ature ~~ -_ ">-a... "
'" ~ \
Date
::~:;::~, yArD
DATE PAIf'1 !/\V\..;J . \0 \qQ~
AMOUNT RECr':1D ~~ . ~
RECEIVED BY 'f1\1~