HomeMy WebLinkAboutPermit Fire Damage Report 1997-3-4
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOT'
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SPRINGFIELD ,. .1, ..,,1 ,
BLOCK:
OWNER' (~Q.,~ .d, \-\l)(\C\ ~
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DESCRIBE ~ORK: \. ~. l.O
NEW REMODE'l1
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JOB NUMBER (\\O\JlJ~~
TAX LOT:
SUBDIVISION'
PHONE:
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STATE: -1) }., ~ (\ nY\
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ADDITION ~ DEMOLISH
CONTRACT~SNAME ^
GENERAL: 'r t\\O~ l N\\J\r\,.
PLUMBING'
MECHANICAl'
ELECTRICA' '
OTHER
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ZIP:
ADDRESS
CONST.
CONTRACTOR'
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- 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' RANG'" , SQUARE FOOTAGE:
To request an InspectIon, you must call 726.3769. This Is a 24 hour recording. 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.
REQUIRED INSPECTIONS
D Temporary Electric
D Slto Inspection - To be made
after excavation, but prior to
setting forms.
D
Underslab Plumbing/Electricall
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 Un'derground Plumbing - PrIor
to filling trench.
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulatfon or decking.
D Floor Insulation - PrIor to
decking, ,
D Sanitary Sewer - Prior 10 filling
trench.
D Storm Sewer - PrIor to fIllIng
trench.
D Water Line - Prior to filling
trench.
Q'Rough Plumbing - Prior to
cover.
D Rough Mechanical - Prior to
cover.
D Rough Electrical - Prior to
cover.
D Electrical Service - MuSI be
approved to obtaIn permanent
electrical power.
o FIreplace - Prior to facing
materials and framIng Insp.
D FramIng - Prior to cover.
SWall/Cellin9 Insulation - Prior to
cover.
[j1'Drywall - Prior to taping.
o Wood Stovo - After Installation.
D Insert - After fireplace approvl1l
and Installation of unit.
D
Curbcut & Approach - After
forms are erected but prIor 10
placement of concrete.
D Sidewalk & Driveway -'After
excavation Is complete, forms
and sub-base material In place.
D Fence - \-Vnen completed.
D Streel Trees - When all required
trees are planted.
/
~inal Plumbing - When all
plumbing w9rl< is complet,e.
D Final Electrical - Wnen arl
electrical work is complete.
D Final Mcchnnlcal - When all
mechanical work Is complete.
~Inal Building - When all
requIred InspectIons have been
approved and buildIng is
completed.
DOther
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 tile home is connected to
the servIce panel.
D Final - After all required
inspections are approved and
porches, sl<lrtlng, 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
;,:,:,...\,
Setbacks
HSE GAR Accl
I
I
.HE 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,
I P,L,
IN
Is
\W
IE
VALUE
"
U\(11).ou
Total Value ~
Building Permit Fcc __ ~ ~
State Surcharge ,9'9\'6.-
Total Fcc (A) ..:.~? ,q~
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM FEW
Fixtures ,~ ,q() ,
Residential Bath(s) N'
Sanitary S~wer FT,
Water FT,
Storm Sewer FT,
Mobile Home
Plumbing Permit 0l),QJ
State Surcharge \.'::>U
, q{}-
Total Charge (C) ~~
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood StovellnsertlFlreplace Unit
Dryer Vent
Mechanical Perml I
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
?Iate Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (exctuding electrical)
(A, B, C, D, and E Combined)
,.l.\-~ ,10
APPROVE['>'
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 Springfteld, 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 duc on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
By signature, I state and agree, thai I have caretully examined
the completed application and do hereby certify that all
informatIon hereon is true and correct, and I further certHy
that any and all work performed shall be done in accordance
with the Ordinances at the City of SprIngfield, and the Laws
of the State of Oregon pertaining to the work described
herein, and thai NO OCCUPANCY will be made of any
structure without permission of the Building Safely 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 at the proper time, that each address Is readable
from tho street, that the permit card Is located at the tront
of the property, and the approved set of plans will remain
on the site at all times during construction.
~J'f/~ -=
(Date ~ 9""/9"/
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~:~:i:~:~MB~R ~d4t5
DATE PAir> ','~ .4-.~ ""
AMOUNT REC~~r \ \ C\ .'57
RECEIVED BY C,\\.~ _ >