HomeMy WebLinkAboutPermit Miscellaneous 1994-6-22
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
OHlce: 726.3759
LOT'
.
SPRINGFIELD
BLOCK'
'~- ~
OWNER: 1\ ,~J _ 0 y ;;>
:~~~l\'QJ! jn~~~at
DESCRIBE WORK:~ t} ~~Y\I'I\rt ~
NEW
REMODEL
CONTRACT<{'\,S NAME
GENERAL~ \l~ \'(10 f)
PLUMBING'
MECHANICAl'
ELECTRICAl'
ADDITION
DEMOLISH
OTHER
.
qW~q.~
JOB NUMBER
225 Fifth Slreet
Springfield, Oregon 97477
TAX LOT'
SUBDIVISION'
(JJ1.{U I
PHONE:m.Jn'~'W3.9
ZIP:
G{iWlB
4;1
ADDRESS
CONST.
CONTRACTOR #
PHONE
EXPIRES
-- OFFICE USE -
QUAD AREA' LAND USE: FLOOD PLAIN:
# OF BLDGS: # OF UNITS: ZONING CODE:
OCCY GROUP' CONSTR. TYPE: # OF BDRMS'
# OF STORIE~' HEAT SOURCE: SECONDARY HEAT:
WATER HEATER' RANGF' SQUARE FOOTAGE:
To request an Inspection, you must call 726-3769. This Is a 24 hour recording. All Inspecllons 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.
D Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
seltlng forms.
D Underslab Plumblng/Electrlcall
Mechanical - Prior to cover.
~FOOtlng - After trenches are
~ excavated.
D Masonry - Steel location, bond
beams, grouting.
~ Foundation - After forms are
erected but prior to concrete
. placement.
D Underground Plumbing :- Prior
10 IIIIlnQ trench.
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
rB Floor Insulation - Prior to
I decking.
D Sanitary Sewer - Prior to filling
trench. .
D Storm Sewer - Prior to filling
trench.
D Water line - Prior to tilling
,trench. .
D Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
~r.tq~
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
.~ramlng' - Prior to cover.
D Wail/Ceiling Insulation - Prior to
cover.
D Drywall - Prior 10 laplng.
D Wood Stovo - After Installation.
D Insert - After fireplace approval
and Installation of unit.
D Curbcul & 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.
D Fence - When completed.
o Slreel Trees - When all required
trees are planted.
D Final Plumbing - When ell
plumbing work Is complele.
, ,
~Inal Electrical - When all
'-P ~Iectrlcal work Is complete.
D Final Mechanical - When all
mechanical work Is complete.
'~Flnal Building - When all
required Inspections have been
approved and building Is
completed.
tlOther &h .
MOBILE HOME INSPECTIONS
D Blocking and Set.Up - When all
blocking Is complete.
D Plumbing Connections - When
home has been connected to
water and sewer.
D Electrical Connection - When
blocking, set.up. and plumbing
Inspections have been approved
and the home Is connected to
the service panel.
D Final - Aller all required
Inspections are approved and
porches, skirting, decks. and
venting have been Installed.
j'
Lot facos
Lot ~YP.
Lot sq. fig.
Interior
Lot coverage
Corner
Topography
TOlal height
Panhandle
Cui-dc-sac
I.
." ~i",.~ !.:;"::~;
'IS THE PROPOSED WORK IN THE
'''HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, Ihls eppllcatlon must be signed
and approved by Ihe Historical
Coordinator prior to permit Issuance.
Setbacks
HSE GAR Accl
I
I
I P.L.
IN
Is
Iw
IE
BUILDING PERMIT
ITEM sa. FT. x $/SO. FT. ~ VALUE
Main
Garage
Carporl
TOlal Value
TOlal Fcc
(A)
"
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
Moblte Home
Plumbing Permit
Stalo Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
N'
Wood StovellnsertlFlreplece Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Tolal Permll
(0)
MISCELLANEOUS PERMITS
Mobile Home
Stale Issuance
State Surcharge
Sidewalk
fI
Curbcut
ft
Demollllon
Stale Surcharge
Total Miscellaneous Permlls
(E)
FEE
TOTAL AMOUNT DUE (excluding electrical) ~
(A, B, C. 0, and E Combined)
APPROVED'
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 al any time
upon violation of any provisions of said ordinances.
Plan Check Fee:
Dale Paid:
Receipt Number.
Received By:
Plans Reviewed By
Dale
Systems Development Charge Is duc on all undeveloped
properl.les within the City limits which are being Improved.
ADDITIONAL COMMENTS
By signature, I stale and agree, that I have carGfully examined
the compleled application and do hereby cerllfy that all
Informallon hereon Is true and correct, and I further certify
that any and all work performed shall be done In accordance
with the Ordinances ollhe Clly of Springfield, and the Laws
of tho Slato 01 Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be made of any
structure without permission or Ihe Building Salely 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 ensuro (hal all rOQulred Inspections are
requested at the proper lime, that oach address Is readable
from the street, that the permit card Is localed at the front
of the property, ~~~ approved set of plans will remain
::,::;:'Ct(;:";f"~1
Date /~
../
VALIDATION:
RECEIPT NUM~ER
DATE PAID 10 .
AMOUNTRECEl~lr"^A )
RECEIVED BY -Q:\.lk:ll.l _