HomeMy WebLinkAboutPermit Building 1996-12-24
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
.
SPRINGFIELD
LOCATION OF PROPOSED WORK: b/?/
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ASSESSORS MAP'
LOT:
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BLOCK:
DESCRIBE WORK: ,/(V~/~7)c-~ ~~~ .-:
NEW
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERAl' .n---:~'7''''
PLUMBING'
MECHANICA' .
ELECTRICAl'
DEMOLISH
OTHER
.
JOB NUMBER ~ /;:;~./
225 Fifth Street
Springfield, Oregon 97477
TAX LOT:
SUBDIVISION:
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PHONE:
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_ ZIP' ~?,Y2Y
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ADDRESS
CON ST.
CONTRACTOR #
EXPIRES PHONE
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
rtI Rough Electrical - Prior to
.J,.L-J cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
rn Framing - Prior to cover.
D Wall/e'elllng Insulation - Prior to
cover.
I)(] Drywall - Prior to taping.
D Wood Slove - After Installation.
D Inserl - After fi.replace approvl!I.l
and Installation of unit.
o
Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
~
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- OFFICE USE -
QUAD AREA" LAND USE: FLOOD I'LAIN'
# OF BLDGS: . OF UNITS: ZONING CODE:_
OCCY GROUP' CONSTR. TYPE: . OF BDRMS:
. OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANG"' SQUARE FOOTAGE:
To request an Inspection, you must call 726-3769. This Is a 24 hour recording. Alllnspecllons request~d 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 SUe Inspection - To be made
after excavatIon, but prior to
setting forms.
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
D Masonry - Steel location, bond
beams, grouting.
D Foundation - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D Underlloor Plumbing/Mechanical
_ Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
D Floor Insulation - Prior to
decking,
D Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior 10 filling
trench.
D Water Line - Prior to filling
trench.
[E) Rough Plumbing' - Prior to
cover..
o Sidewalk & Driveway - After
excavation Is complete. forms
and sub.base materIal In place.
D Fence - When completed.
o Streot TreQs - Wh~n all required
trees are planted.
rl71 Final Plumbing - When all
lJ:L.I plumbing w9r!< Is complet.e.
r7l Final Electrical - When all
L,.LJ electrIcal worl< is complete.
rn Final Mechanical - When all
mechanical work Is complete.
[Z] Final Building - When all
requIred Inspections have been
approved and building Is
completed.
IX! Other
,:1:. . ~"V~
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MOBILE HOME INSPECTIONS
D Blocking and Set-Up - When all
blockIng is complete.
D Plumbing Connections - When
home hos 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 - After all required
inspections are approved and
porches, skIrting, decks, and
venting have been installed.
Lot racos Lot Type
Lot sq. ftg. Interior I P.L.
IN
Lot coverage Corner
Is
Topography Panhandle
Iw
Total height Cui-dc-sac
IE
BUILDING PERMIT
ITEM SQ. FT. X $/SQ. FT. = VALUE
Main
Garage
Carper.t
~/", ~.rC
"
Total Value
.?~
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7S"',//
Building Permi t Fee
Stale Surcharge
Tolal Fcc
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(8)
PLUMBING PERMIT
ITEM
FEE
::<:.? ......
Fixtures '2..
Residential Bath(s) N'
Sanitary S~wer FT.
Water FT.
Storm Sewer FT.
Mobile Home
<1P p-/.:?7"1"~
/~.->
9"'): .-:::>'
f-l . -~~
~7,iJo
PlumbIng Permit
State Surcharge
Total Charge (C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/Insert/Fireplace Unit
Dryer Vent
~ ~V'~.
Mechanical Permit
~//I'
o
/<)'. --
/0.-
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Issuance
Stale Surcharge
Total Permit
(0)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcul
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
2~.//
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_S THE PROPOSED WORK iN THE.
. ...HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, Ihis application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
'Setbacks
HSE GAR ACC
...
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PE.RMIT
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 ordln~nces.
Plan Check Fee'
2/./.'":;'
Date Paid:
Receipt Number'
Received By;
Plans Reviewed By
Date
J
J
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
Ole compleled 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 wIthout permission of the Building Safety Division.
I further ~ertlfy thai only contractors and employees who
arc 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, that each address is readable
from the street, that the permit card Is located at the fronl
of the property, .3nd the approved set of plans will remain
on the site at all times d_U;!-;~ construction.
Slgnaturill..~~
'-./ -
Date
1.2-;;).1-'7/.
,
VALIDATION:
RECEIPT NUMBER 24-"/') 7
/2-?l,/-"9b
AMOUNT RECEIVED 1~,::?Lj'
RECEIVED BY _~.. .
DATE PAID