HomeMy WebLinkAboutPermit Building 1995-2-28
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
ASSESSORS MAP'
LOl'
S"
BLOCK'
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ADDREI'''' :$ 'S- '6 S' YvI .p. \ N
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OWNER'
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CITY'
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STATF' .
OrL-
DESCRIBE WORK: 5 C::-~-,-\ t-1 b ~
NEW 7 9' REMODEL ADDITION
CONTRACTOR'S NAME
f) llJ tJ SfL
GENERA' .
PLUMBIN'"
MECHANICAl'
ELECTRICA' .
t
QUAD AREA:'" ~ ~ ^-~(l j
# OF BLDGS:---,'
OCCY GROUP:
# OF STORIES:
WATER HEATER:
9/
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JOB NUMBER
225.Flfth Street
Springfield, Oregon 97477
TAX LOT:
.SUBDIVISION:
o~
PHONF'
( l..-~ -830~
ZIP:_Y '( Lf7 P
Ml\-"-IUF-ACtUlU"O \'tOML- (J,J GoT/'l-C.IDIIJ,tfl,,(IJIIt!J'-
.J I Q 7q 81-0....11 H-,. "'f' 1-t\ '-...h ill
I'- DEMOLISH OTHER I ':"'.......:.._..:.._. .t"'fl"J ..rl ~1T1tJ ~
:J CONST; .
ADChSS . CONTRACTOR #0 EXPIRES PHONE
"'llA'OL~ '. ;
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D Rough Mechanical -: Prior to
cover.
~Uilh Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
~r8~lng - Prior~ to cover.
~celltng InsJlatlon - Prlor'to
cove~ .
~ryWall - Prior to taping.
D Wood Stovo - Aftl,r Installation..
o Insert - After fireplace approval
and Instaflatlon of unit. .
O'Curbcut & 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 Fen~e ~ When ~omPleted.
o Street Trees - When all required
trees are planted. .
.
FLOOD PLAIN:
ZONING CODE:
# OF BDRMS'
0('"
- OFFICE USE -
LAND USE: . r=<::?DO
# OF UNIT:'"
CONSTR. TYPE:
HEAT SOURCE:
RANG'" C(./
~f/
SECONDARY HEAl'
SQUARE FOOTAGE:
\DtoL
To request an !nspectJon, 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 sfter 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
l' .~,
D Temporary Electrl~
O Site Inspoctlon - To be mado
after excavation, but prior to
setting for~. ~
nz( Underslsb ~Iectrlcall
Mechanical Prior to cover.
~ooUng - After trenches are
excavated.
D Masonry - Steel location, bond
,beams, grouting.
~oundatlon - After forms Bre
~ ;~ected but prior to'concrete
placement.
o Underground Plumbing - Prior
to filling trench.
o Underfloor Plumblng/Mechanlcsl
-.Prlor to Insulation or decking.
~st and -Beam - Prior to floor
Insulation !,r decking.
~or insulaUon - Prlo! to
decking. .
~anltary Sewer - Prior to filling
trench. .
~Storm Sewer - Prior to filling
~ trench.
~ator Llno -'Prlor to filling
~ ;~nCh.
\ tS' R-o'ugh '~lu~bl~g - Prior to -
cover.
D Final Plumbing - When all
plumbing W9rk Is complete.
--
IVI I-Inol Electrical - \N.hen all
electrical work Is complete. C
D Final Mechanlcsl - When all
mechanical work Is complete.
~I Building - When all
required Inspections have been
approved snd building Is
completed.
[j2f6ihor h1hulh?/..J_ ~l=t/U-
r:peH?~ ~~l'
MOBILE HOME INSPECTIONS
~Cklng and Set. Up - When"all
blocking Is complete. .
~Iumblng Connections - When
home has been connected to .
water and sewer.
., ..-.
~lectrlcal Connecllon - When
blocking, set.up, and plurt;lblng
Inspections have been approved
and the home Is connected to
the service panel.
G'flnal'- After all'requlred
Inspections are approved and
. p'orches, skirting, decks, and
venting have been Installed.
,
Lot faces
Lot TY.',
Interior
Lot sq. ftg.
Lot coverage
Corner
Topography
Total ~elght
Panhanqle
Cul-de-sac
BUILDING P6RMIT
ITEM SO. FT. X $/SO. FT.
f0aln
Ga(age
Carport
-;&:, ;a...
,~7)l4"""'~) ~
A)4.1 z.I'~_
I I
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Total. Value
Building Permi t Fee
State Surcharge + 2Sro (." '(3 r-1.04
Total Fee
(A)
Setbacks
PL. HSE GAR
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Is
lw
IE
VALUE
"
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'I~A.
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SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) . lioQQL1
ADDITIONAL COMMENTS
o ~ 1 - "i77hbf?J; ltJa~. 7-0 -..t56r
j/feJ' IY<;VItt:l!ot, J A?$ql.....~....'\v::r'
\.. .~ T: 1~.,4'JO .
\.i ~NJ f).o.tIJ;' \0lon
1A411.D ~ ~ =It' ~"7/')O. #0
() MOS IlA-Tlf~ /U1tN PRe IS
P'6J/Iuff2&{j 1St( -, ){lJ.X1 nrl p,1 --\.{')
~''(fn ) ~,anp" ,
3'i: (W!'r ~ -. --0 4110/'w.l.fdNJCLf -mL PJ(~,r ,t(~?:f M-'" 11617
..; () g,.. TPD ~ S~~ -FLh{ ;O/;.(1N'T ".-<' .#$
(C)
PLUMBING PERMIT
ITEM
Fixtures
,
Residential Bath(s)
N'
Sanitary Sewer
Water
FT.
FT.
Storm. Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stovellnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuahce
State'Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk P1 ft
aft
n~-~lltI"o ~O
Curbcut
Slate Surcharge
,~X\ \;0.") OLU ksrn
Total Miscellaneous Permits (E).
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
'4f).W
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~OaJ
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. i{t=).CO
J;)O .W
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, .IS THE PROPOSED WORK tN THE_,
....HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the HistorIcal
Coordinator prior to permit Issua~ce.
ACe' I
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APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condttlon that the said
constructfon shal'" In' all respects, conform to the Ordinance
adopted by the City of Sprlngfteld, 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'
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
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By signature, I state and agree, that I have carefully examlnea
the completed application and do hereby certify that all
Information hereon Is true and correct, and I further certify
thai any and all work performed shall be done in accordance
with the Ordlnanc~s 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 Ihe Building Safety Dtvlslon.
I further certify that only contractors and employees who
are In compliance with ORS 701.055 will be used on this
project.
Inspections are
VALIDATION:
,Lki..,4()
2/2 ~."r
AMOUNT RECEIVED ~ ~z.:.I, 44
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RECEIPT NUMBER
DATE .PAID
'_.I_~yj
RECEIVED BY _