HomeMy WebLinkAboutPermit Miscellaneous 1995-5-17
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
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SPRINGFIELD
,
LOCATION OF PROPOSED WORK: 5""'J5 ??1' 79
ASSESSORS MAP' /? C2. - ~ /" --: "75
LOT:
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BLOCK'
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JOB NUMBER ~y /'2"7::::2...
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225 Fifth Street
Springfield, Oregon 97477
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TAX LOT-
SUBDIVISION-
<O..o~~
OWNER-
ADDRESS-
/"/f#~ ,<77n.-?~-;,
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~~~d? STATE:_~.
CITY:
PHONE: h!z4CjI-.!5:;T"",?~
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ZIP:
9? rR /
DESCRIBE WORK- /..a/~/ /. .!!-~/...z...oX: J?~ ~./-=: 7~'--" f' ..7 ~~.~ ~
NEW REMODEL ADDITION DEMOLISH OTHER . _
CONTRACTOR'S NAME
GENERAl'
PLUMBING:~
MECHANICAL'
ELECTRICAl'
ADDRESS
CON ST.
CONTRACTOR'
PHONE
EXPIRES
A
~
.~
T '"
- OFFICE USE -
QUAD AREA- LAND USE: FLOOD PLAIN:
. OF BLDGS: . OF UNITS' ZONING CODE:_
OCCY GROUP' CONSTR. TYPE: . OF BDRMS'
. OF STORIES' HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGE: __ 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.
REQUIRED INSPECTIONS
D Temporary Electric
D SlIe Inspection - To be made
after excavation, but prIor to
setting forms.
o Under.lab Plumblng/Electricall
Mechanical - PrIor to cover.
o Fo'otlng - After trenches are
excavated. .. '
o Masonry - Steel location, bond
beams, grouting.
D Foundation - After forms are
erected but prior to concrete
placement.
o
Underground Plumbing - Prior
to (llIlng trench.
o
Underfloor Plumbing I Mechanical
- Prior to Insulation or decking.
D Post and Beam' - Prior to floor
Insulation or decking. ,
o Floor Insulation - Prior to
decking. __.
o Sanitary Sewer - Prior to fllllng
trench.
lXl
o
Storm Sewer - Prior to filling
trench.
Waler Line - Prior to IIIIlng
trench.
D
Rough Plumbing - Prior to
cover.
o Rough Mechanical - Prior to
cove~ .
D Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Flreplac~ - ~rlor to facing
materials and framing Insp.
o Framing - Prior to cover.
o Wail/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping.
o Wood Stovo - After Installation.
o Insert - After fireplace approve/
and Installation of unit.
o Curbcut & Approach - After
(orms are erected but prior to
placement of concrele.
o Sidewalk & Drivewav - After
excavation Is complete, forms
and sub.base material In place.
o Fence - When completed.
o Street Trees - When all required
trees are planted.
o Final Plumbing - When all
plumbing work Is complete.
. .
D Final Electrical - When all
electrical work Is complete.
o Final Mechanical - When all
mechanical work Is complete.
o Final Building - When all
required Inspections have been
approved and building Is
completed.
DOthor
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
b/pcklng, 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 Type.
Lot sq. ftg.
Interior
Lot coverage
Corner
Topography
Panhandle
Total height
Cul-de-sac
BUILDING PERMIT
ITEM
SQ. FT.
X $/SQ. FT. ~
Main
Garage
Carport
Total Value
Building Permit Fee
Stale Surcharge
Total Fee
(A)
" .l.ll, .'
. /7 ~
\. THE PROPOSED WORK IN 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
I I I
HSE GAR ACC
I P.L.
IN
Is
Iw
IE
VALUE
-,
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanitary Sewer FT.
Water FT.
Storm Sewer FT. .At?
Mobile Home
Plumbing Permit
State Surcharge
:~
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(0)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
ft
Demolition
State Surcharge
Tolal Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
FEE
y/?
y~-=
/. ::2P
~2V'
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 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 state 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 descrlbed
herein, and that 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 OAS 701.055 will be used on this
project.
I further agreo to ensuro 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 site at all times during construction.
Signature ~ ~ '---.....
)-//-~~
Date
VALIDATION:
RECEIPT NUMBER / 7C// "?
.;;--h-'95"
AMOUNT RECEIVED ~-=?:Z.::?
RECEIVED BY .~~-
v
DATE PAID