HomeMy WebLinkAboutPermit Building 1993-1-4
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
.
SPRINGFIELD
LOCATION OF PROPOSED WORK: ./'?ce? ,/(p#M/ ~
ASSESSORS MAP' / '7-P"?-"3"~-S'2 .
LOT:
BLOCK'
0~~C ~ ~~~'.:;;'C7'?-
OWNER:
ADDRESS'
CITY'
DESCRIBE WORI<'
NEW
REMODEL
CONTRACTOR'S NAME
GENERAL'
PLUMBING'
MECHANICAl ~&:v;pr:f6~
ELECTRICAl'
QUAD AREA"
# OF BLDGS:
OCCY GROUp.
# OF STORIES:
WATER HEATER'
STATIO.
ADDITION
DEMOLISH
OTHER
.
. JOB NUMBER
"9 7f ~:-c>/
225 Fifth Street
Springfield, Oregon 97477
TAX LOT: t:....; ~ 7<:5 /
SUBDIVISION'
PHONF'
"*
J
ZIP'
ADDRESS
CONST.
CONTRACTOR #
PHONE
REQUIRED INSPECTIONS
(XI Rough Mechanical - PrIor to
cover.
D Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
.
o Fireplace - Prior to facing
materials and framing Insp.
o Framing - Prior to cover.
o Wail/Ceiling .Insulation - Prior to
cover.
o Drywall - Prior t? taping.
o Wood Stovo - After Installation.
o Insert - After fireplace approvQI
and Instal/at Ion of unit.
o Curbcut & Approach - After
. fCl[ms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
o Fence - When completed.
o Street Trees - When all required
trees are planted.
EXPIRES
:?"~z,~~~~ -S.~b~_
;. I' ,-, ,
..2 ~-93. ?l.I4-~:>
, . .
FLOOD PLAIN'
ZONING CODE:
# OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE:
To request an Inspection, 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 after 7:00 a.m. will be made the following work day.
- OFFICE USE -
LAND USE:
# OF UNITf"
CONSTR. TYPE:
HEAT SOURCE:
RANGE:
o
Final Plumbing - When all
plumbing w9rk Is complet.e.
o Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumblng/Electricall
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting.
o Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
o Underfloor PlumbIng/Mechanical
- Prior to Insulation or deckIng.
o Post and Beam - Prior to floor
Insulatlon or decking.
o Floor Insulation - Prior to
decking,
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench. .
o Water Line - Prior to filling
trench.
o Rough Plumbing - Prior to
cover.
D Final ElectrIcal - When all
electrical work Is complete.
r17l Final Mechanical - When all
!,..l\.J mechanical work Is complete.
o Final BUilding - When aI/
required Inspections have been
approved and building Is
completed.
o Other
MOBILE HOME INSPECTIONS
o Blocking and Set.Up - When all
blocking Is complete.
o Plumbing Connections - When
home has been connected to
water and sewer.
o Electrical Connection - When
blocking, set-up, and plumbing
Inspections have been approved
and the home is connected to
the service panel.
o Final - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been installed.
., THE PROPOSED WORK IN THE
""HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this appl/cation must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
Lot faces ~ot ;ype. Setbacks
I P.L. I I I
Lot.sq. ftg. Interior HSE GAR ACC
IN
Lot coverage Corner
Is
Topography Panhandle
Iw
Total height Cul-de-sac,
IE
BUILDING PERMIT
ITEM SQ. FT. X $/SQ. FT
VALUE
Main
Garage
Carport
"
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath{s)
NO
Sanitary Sewer
FT
Water
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace o/;f1-5
Exhaust Hood
~--
Vent Fan
NO
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Mechanical Permit
/1J /,I'f ,
/~-:- ~
/.0, -'"
.7S-
"25: 7S""'
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobl/e Home
State Issuance
State Surcharge
Sidewalk ft
Curbcut
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
APPRO\(ED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
. This permit is granted on the express condition that the said
construction shall; in all respe"CIS, 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 Check Fee'
Dale Paid:
Receipt Number
Received By:
Plans Reviewed By
Date
,. -
Systems Development Charge Is due of"! all undeveloped
properties within the 'city limits which are being improved.
ADDITIONAL COMMENTS
By signature, I state 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 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 the work described
herein, and that NO OCCUPANCY wll/ be made of any
structure without permission of the Building Safety Division.
I further certify that only contractors and employees who
are in cO'!lpliance 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, CJ the approved set of plans will remain
on the site at times du.ring ns n.
Signature ~
{
Dale J 1'I/9"J,
---#- I I -
VALIDATION:
RECEIPT NUMBER
DATE PAID
71~6
(-e.,/-"7? :;:;
2. "5:_75
-:/?~ ->
,
AMOUNT RECEIVl=n
RECEIVED BY"