HomeMy WebLinkAboutPermit Building 1997-7-14
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOT:
BLOCK'
SUBDIVISION'
OWNER: \ t~ \ \\\\\\ ~, ~~S~. PHONE:14 In -~~ \
ADDR~1\1 ~;~ P.), '\\\\t)\ ~~oo r :t\:~
CITY:~~~ STATE:~it)Y\. ZIP: Uli\-11
DESCRIBE WORK: ~\ \ l 'J1(\ L l.J\'\f't'>~ \ 0 .l '~'t{Y\. 0
NEW REMODEL - - ~DDITION DEMOLISH OTHER
CONST.
CONTRACTOR'
CONTRACl"WS NAME
GENERA' . 0X\o ~
PLUMBIN'" k.)t\o~
ADDRESS
EXPI'4, ~S~ ..
~
AJ
, '\\
PHONE
MECHANIC'" '(
ELECTRICAL: l~) ~ ~ lV\O 1O ...
- OFFICE USE -
QUAD AREA'
. OF BLDGS:
LAND USE:
FLOOD PLAIN:
ZONING CODE:
. OF UNITS'
OCCY GROUP'
CONSTR, TYPE:
HEAT SOURCE: ."Q..'f..
~- :\
WATER HEATER: RANGE: (~<(.. f-~Cl SQUARE FOOTAGE:
~Ii-.~ .,0(\ Y ..
,. :(:.'(" Go\..)"
To request an Inspecllon, you must call 726'~Zll.!lC:: !!\C!Pil'"~~IJr racordlng. Alllnspecllons requested before 7:00 a.m. will be
made the same working da~ti\~~~~~~lf~~~;'pw~~~~~~d; the [allowing work day.
o Temporary Electric '\~<:o '''Cl~~-C<'0P~o 'Mechanical - Prior to 0 Final Plumbing - When all
~<\~ "'-\~( ~ plumbing wc;>rl< Is complete.
~v ~~~' ~ .
o SUe Inspection - To be m~ ,~~ Rough Electrical _ Prior to
after excavatlon, but prior to ....\." cover.
setting forms. ~'
. OF BDRMS'
. OF STORIES:
SECONDARY HEAT:
D Final Electrical - When all
electrical work Is complete.
o Underslab Plumbing1Electrlcal/
Mechanical - Prior to cover.
o Final Mechanical - When all
mechanIcal work Is complete.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Footing - After trenches are
excavated.
o Final BuildIng - When all
required Inspections have been
approved and building Is
completed.
o Fireplace - Prior to facing
materials and framing Insp.
o Masonry - Steel location, bond
.beams. grouting.
o Foundation - After forms are
erected but prior to concrete
placement.
o FramIng - Prior to cover.
o Other
o WalllCelllng Insulation - Prior to
cover.
o Underground Plumbing - Prior
to filling trench.
o Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
o Underlloor Plumblng1Mechanlcal
- Prior to Insulation or decking.
o Wood Stovo - After 1~5tallatlon.
n Blocking and Set.Up - When all
~Iocklng Is complete.
o Post and Beam - Prior to floor
Insulation or decking.
o Insert - Atter fireplace approvllI
and Installation of unit.
o Floor Insulation - Prior to
decking.
rIl plumbing Connections - When
~home has been connected to
water and sewer,
o Curbcut & Approach - After
forms are erected but prior to
placemont of concrete.
o Sanitary Sewer - Prior to filling
trench.
II ~ctrlcal Connection - When
LV"blocklng, set-up, and plumbing
Inspections have been approved
and the home Is connected to
. i service panel.
rn;!~al - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
o Sidewalk & DrIveway - After
excavation Is complete, forms
and sub.base material In place.
o Storm Sewer - Prior to filling
trench.
o Fence - When conlpleted.
o Water Line - Prior to filling
trench.
o Rough Plumbl~g - Prior to
cover. '
o Street Trees - When all required
trees are planted.
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Lot faces Lot TYpe
Lot sq. fig, Interior I PL.
IN
Lot coverage Corner
Topography Panhandle ; Is
Iw
Total height Cul.de.sac
IE
BUILDING PERMIT ,)
ITEM sa. FT.
'.
.'/
X $/SO. FT. =
VALUE
Main
Garage
Carport
"
Total Value
Building Permit Fee
Stale Surcharge
Total Fec
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s)
N'
Sanitary S~wer
Water
FT.
FT.
FT,
Storm Sewer
Mobile Home
LC\ ,OU
Plumbing Permit
~
, 'S ,W
\,'1..0
l\o.W
State Surcharge
~"b<J7D
Total Charge
(0)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stovellnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
St~te Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
I (p5X>
AO.ro
'~10
State Issuance
State Surcharge
~ 5")0
Sidewalk
fI
Curbcul
It
Demolition
Sta~ Surcharge .,,':..J......
\ Q.. 0 ~\..f) Q }J Ul.\A..\
~otal Mlsc:lanebus Permits
'\
~,W
(E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
>i"~' ~. ~ .~ .J ~;: ;; fj~, ~N.':~ r.
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Setbacks .
HSE GAR ACC'
IS THE PROPOSED WORK IN THE.
"HISTOI;lICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this appllcallon must be signed
and approved by. the Historical
Coordinator prior to permit Issuance.
APPROVED:
BUILDING VALl1E, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condillon that Ihe said
construction shall, In all respects, conform to the Ordinance
adopted by the City of Springfield, Including the
Development Code, regulallng the construcllon 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
. Dale
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
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By signature, I stale and agree, Ihat I have carefUlly examined
the completed application and do hereby certlly 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 tho work described
herein, and that NO OCCUPANCY will be made of any
structure wllhout permission of the Building Safety Division.
I further certify that only contractors and employees who
are In compliance wllh ORS 701.055 will be used on this
project.
I further agreo to ensuro 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, an7rth pproved sel of ~Will remain
on the site at all, tlm7ul7~tructlon.
Slgnat~ I ~-1/ ..,I/~'
Date /' ! /4, 'k ,CJ7
I r/ ..
VALIDATION: 1\1
RECEIPT NUMBER (^-\d.~
DATE PAID f\. \l:\-.'?J
AMOUNT REC~V'D . \ q ~ . ~C)
RECftlVED BY 'ftILf'vr\ ./
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225 FIFTH STREET
SPRINGFIELD, OR 97477
(503) 726-3753
FAX (503) 726.3689
MOBILE HOME AND MANUFACTURED HOME AGREEMENT
UNITS TO BE PLACED IN A PARK
As required by the City of Springfield De~elopment Code and/or the State of
Oregon, I understand and agree, as shown by my signature on this form, that with
the approval of_the t\ta~h~~permits for a home to be located at
l~\n~ \ 'U\(\ I {\ "'\>~~ ' Springfield, Oregon, Ci ty Job Number
tl~~~t;; '1 will meet or exceed the below listed minimum setbacks.
Home 'Setbacks
10 feet from a park building
20 feet from any public street
5 feet from any rear space 1 i.ne or interior space line
5 feet from the edge of a park street
2 feet front" the interior edge of a park sidewalk
Accessory Structure Setbacks
10 feet from a park building
20 feet from any public street
5 feet from the edge of a park s tree t
2 feet from the in terior edge of a park sidewalk
3 feet from an in terior space line or rear space line
I further state, by my signature below, that I have been provided with the
following information:
Manufactured Home Blocking Requirements
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Signa ture tI / /
- Electrical Connection
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DateV 0
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'I IlDNa . . OCCUPANcY GIOOU~.. \ , . /
;1' II..,,.. I I OcCUPANCY' LoAD
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AL1"BfM'nete INDlCA11!!:D IN COLOMD PElNCIL. CHANGES
OR AI. , '... I MADS APTIiR DATe: BILOW SHALL BE
AflPRDVIID ., 'TII8 BuILDI... OFPICI"L.
CITY
GFI ELD. OREGON
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