HomeMy WebLinkAboutPermit Building 1996-4-26
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LOCATION OF PROPOSED WORK'S 3 '? c:;
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RESIDENTIAL
PERMIT APPLICATION
Inspecllons: 726.3769
Office: 726.3759
ASSESSORS MAP'
LOT'
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SPRINGFIELD
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BLOCK'
OWNER:
ADDRESS:
CITY:
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STATE:
DESCRIBE WORK: /,~,N?T. k.....,A.7/~
NEW ~EMODEL ADDITION
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DEMOLISH
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9' C;05"t!Y"
JOB NUMBER
225 Fifth Street
Springfield. Oregon 97477
#/77
TAX LOT'
SUBDIVISION'
10/ SC7C)
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PHONF'
ZIP:
q 7~7~
CONTRACTOR'S NAME
GENERAL: n'?&L,
CONST.
ADDRESS CONTRACTOR'
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PHONE
~7 -7'.>.8..("
PLUMBING'
MECHANICAl-
ELECTRICAl'
EXPIRES
Shop'"
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- OFFICE USE -
QUAD AREA: LAND US"- 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 belore 7:00 a,m, will be
made the same workIng day, Inspections requested after 7:00 8.m. will be made the- followIng work day.
REQUIRED INSPECTIONS
D Temporary Electric
D Sito Inspection - To be mado
after excavation, but prior to
setting forms.
D Underslab Plumblng/Eleclrlcal/
Mechanical - Prior to cover.
1'X1 I""ootlog - After trenches are
~ excavated.
D Masonry - Steel location, bond
beams, groutln,g.
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.
o Storm Sewer - Prior to filling
trench.
D Water Line _\ Prior to filling
trench.
o Rough Plumbing - Prior to
cover. ...
D Rough Mechanical - Prior to
cover.
D Rough Electrical - Prior to
cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
ftramlng - Prior to cover,
D Wail/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping,
D Wood Stovo - After Installation.
D Insert - After fireplace approvlSl
and Installation 01 unit,
D Curbcul & Approach - Alter
forms are erected but prior to
placement of concrete.
D Sidewalk & Driveway../. After
. excavation Is compiete: forms
and sub-base material In place.
D Fence - When completed.
D Street Trees - When all required
trees are planted.
D Final Plumbing - When all
plumbing worl< Is complete.
. ,
D Final Electrical - When all
electrical work Is complete.
D Final Mechanical - When all
mechanical work Is complete.
~Inal Building - When all
required Inspections have been
proved and building is
completed.
DOthor
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 - After all required
Inspections are approved and
porches, skIrting, decks, and
venting have been Installed.
Lot faces
Lot.
Lot sq, ltg,
Interior
Lot coverage
Corner
Topography
Total height
Panhandle
Cul.de-sac
BUILDING PERMIT
ITEM SQ, FT,
X $/SQ, FT, =
Main
Garage
Carport .
~/.4'A
Total Value
Building Permit Fee
State Surcharge ;/"'+ .71
Total Fcc (A)
Setbacks
HSEIGAR ACCI
I I
wi I II
J-LLLJ
I P.L,
IN
S
VALUE
'.
/4t; _(TO
,
:z. ~ Flt>
/,'61'
? .:;-_3'7
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary S~wer
Water
FT,
FT,
FT.
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
N'
Wood Stovellnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
Slate Surcharge
Sidewalk II
Curbcul
II
Demolition
State Surcharge
.
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined) -
FEE
"...:',;';
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'I",IS 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.
APPROVED'
I
I
I
BUILDING V~LlJE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall. In all respects, confqrm to the Ordinance
adopted by the Clty.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.
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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 stale and agree, that I have carefully examined
the completed application and do hereby certl fy 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 Ihe City 01 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 Satety Division.
I further certlty that only contractors and employees who
are In compliance with ORS 701,055 will be used on this
project.
I further agree-Io ensuro that all required Inspections are
requested at the proper time, that each address Is readable
from the street, that the pormlt card Is located at the front
of the property, and the approved set at plans will remain
on the site at all times during construction.
Slgnatur~ ~~~~_
Date t1 If - :;.. (p - '9 ?
VALIDATION:
2~/L
DATE PAID ~2.t:P J 6
AMOUNT RECEIVED 5' ,1 r
~p~
RECEIPT NUMBER
RECEIVED BY
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