HomeMy WebLinkAboutPermit Building 1992-12-3
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SPRINGFIELD
RESIDENTIAL
PERMIT APPLICATION
~$
90!o/ S-
JOB NUMBER
Inspections: 726.3769
Office: 726.3759
225 Fifth Street
Springfield, Oregon 97477
ST.
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LOCATION OF PROPOSED WORK:
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IS~
ASSESSORS MAP'
TAX LOT:
SUBDIVISION'
LO'!:
BLOCK'
OWNER:_I?L,L/.//A /f?GY.4'" s /)
ADDRESS" J1'7'f'J ~/f7A] .::;; T'
~/A~r=/~
R~p
74./ - ;:?-r.l :? C
PHONE:
or.< ZIP: q 7~7?
1{61.DfI~ ~ ~Jl!-/V'_
CITY:
STATE:
,fiJ<
DESCRIBE WORK:
REMODEL
NEW
ADDITION
DEMOLISH
OTHER
CON ST.
CONTRACTOR'
7L1{>?{,
CONTRACTOR'S NAME
GENERAL: 411 dWlPd,,,,,,- /",.,~< J-
ADDRESS
/!Ih. / fl!-j"
EXPIRES PHONE
t,-/t4.-9'? 72./,-?7(,o
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PLUMBING'
MECHANICAl'
ELECTRICAl'
- OFFICE USE -
QUAD AREA:
. OF BLDGS'
OCCY GROUP'
. OF STORIES:
WATER HEATER'
LAND USE:
FLOOD PLAIN'
. OF UNITS'
ZONING CODE:
CONSTR. TYPE:
HEAT SOURCE:
RANGE:
. OF BDRMS'
SECONDARY HEAT:
SQUARE FOOTAGE:
To request an Inspection, you must call 726-3769. This 15 a 24 hour recording. AI/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 Rough Mechanical - Prior to
cover.
D Final Plumbing - When all
plumbing w9rk Is complete.
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Rough Electrical - Prior to
cover.
o Final Electrical - When all
electrIcal work is complete.
D Underslab Plumblng/Electrlca"
M!jtchanlcal - Prior to cover.
D Final Mechanical - When all
mechanical work Is completo.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Footing - After trenches are
excavated.
l'V"I Final Building - When all
~qulred Inspections have been
approved and building is
completed.
D Fireplace - Prior to facing
materials and framing Insp.
D Masonry - Steel location, bond
beams, grouting.
~ramlng - Prior to cover.
K7f Wail/Ceiling Insulation - Prior to
~cover.
DOther
D Foundation - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench,
~rYWall- Prior to taping,
MOBILE HOME INSPECTIONS
o Underlloor Plumbing/Mechanical
- Prior to Insulation or decking,
D Wood Stove - After I~stallation.
D Blocking and Set-Up - When all
blocking Is complete.
,
D Post and Boam - Prior to floor
_ Insula~lon or decking.
D Insert -:- After fireplace approvl1l
. and Installation of unit.
D Plumbing Connections - When
home has been connected to
water and sewer.
D Floor Insulation - Prior to
decking,
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sanitary Sewer - Prior to filling
trench.
D Electrical Connection - Whon
blocking, set-up, and plumbing
inspections have been approved
and the home Is connected to
the service panel.
D Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material In place.
D Storm Sewer - Prior to filling
trench.
D Fence - When completed.
D Water line - Prior to filling
trench.
D Final - Alter all required
Inspections are approved and
porches, skirting. decks, and
venting have been Installed.
D Street Trees - When all required
trees are planted.
D Rough Plumbing - Prior to
cover.
Lot faces
LOI sq, flg,
Lot coverage
Topography
Total height
, . ,.
~ot T:~.
Interior
Corner
Panhandle
Cui-de-sac
BUILDING PERMIT
ITEM SQ, FT, X S/SQ, FT,
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
~l" ,,:, I ":.,1; . )'_:.~;_. .,to
'7 .f"1.'f!.'" ""'~;'11'~"~~ ...
'. ~~ .J_., t :' I },l ~ .,' I'~, I' ,-- .
~ , '~ 11 .' t.." ' t \
I P.L.
IN
Is
Iw
IE
VALUE
"
/~"P'!D
2~f.o
/.:J3
SYSTEMS DEVELOPMENT CHARGE (SDC)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanitary Sewer FT,
Water FT.
Storm Sewer FT,
Mobile Home
Plumbing Permll
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
(B)
(C)
Dryer Vent
Wood Slovellnsert/Flreplace Unit
N'
Mechanical Permit
Issuance
State Surcharge
Total Permit
Mobile Home
MISCELLANEOUS PERMITS
(D)
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
fl
Demolition
State Surcharge
/2/..4. ?bz.l.
TOlal Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A. B, C, D. and E Combined)
FEE
/7,3:1
4c; / (p
. ~-
Setbacks
HSE GAR Accl
I
I
.IS THE PROPOSED WORK IN THE
HISTORICAL DISTRIC1; OR ON
THE HISTORICAL REGISTER?
If yes. this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
APPROVED'
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit 15 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 Clleck Fee: __/ 7 .]:1
Date Paid:
Receipt Number
Received By:
~~~~
/2!)h 2-
(Datli
Systems Development Charge Is due on all undeveloped
propertles 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 certify that all
Information hereon Is true and correct, and I further certffy
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
heroin, and that NO OCCUPANCY will be made of any
structure without permission 01 the Building Safety 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 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.
/Xgnmrm-) ~1t LU~a.,
Date / - ~ - 5' '3
VALIDATION:
RECEIPT NUMBER
72/1
J -c,-J's,
-151"
-~~q
DATE PAID
AMOUNT RECEiVEn
RECEIVED BY