HomeMy WebLinkAboutPermit Plumbing 1999-4-2
RESIDENTIAL
PERMIT APPLICATION
LOT:
OWNER'
ADDRESS'
CITY:
CM-J
DESCRIBE WORK'
NEW
REMODEL
CONTRACTOR'S NAME
G~
GENERA' .
PLUMBING:
MECHANICAl'
ELECTRICAl'
QUAD ARE'"
. OF BLDGS'
OCCY GROUP'
. OF STORIES:
WATER HEATER:
.
.
JOB NUMBER
Cj16l{3 ']
225 Fifth Street
Springfield, Oregon 97477
.,
. !./P...JVln..
TAX LOT:~4C OCJ
c/
STATF'. ()It-
ADDITION
DEMOLISH
OTHER
SUBDIVISION'
PHONE:
1 'La. ~ 2-1 "2..1
ZIP:_!!..:? C(7 Y
ADDRESS
Wb.Jh/l/>-.
CON ST.
CONTRACTOR'
9;2'1' "'" q,......
EXPIRES 0 PHONE
7U, :u 7/
'--... .........^
f~l~gt~t9rsu~o~;~~' b;;h~-o;~g~n Utility
LAND l!l1''';H~~tinn Center. Those rules areF.~60Drt~LAIN'
in nAR 952-001-0010 through OAR 9"'7-uv1-
· OF UNIJS: u -'- --"',)$ of th~ZXi)NINGYCODE:
OU1:1U. TUU ilia} .......~........ --r- one
CONSTR. TxelM thp. center. (Note:t~e tel~~IJ5~i ~pRMS'
IImher for the Oregon Utility Notlflca 10
HEAT SOIlRCE: .:,,,,,,,,,;~ 1 3:: ?"';>-2344) SECONDARY HEAl'
RANGF' SQUARE FOOTAGE:
To request an Inspecllon, you must call 726-3769. This Is a 24 hour recording. Alllnspecllons 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.
D Temporary Electric
D Sfte Inspection - To be made
after excavation, but prior to
setting forms.
D Underalab PlumbIng/Electrical/
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
D Maaonry - Steel locallon, bond
beams, grouting.
D Foundation - After forms are
erected but prior 10 concrete
placement.
D Underground Plu'!'blng - Prior
to filling trench.
D Underfloor Plumbing/Mechanical
- Prior to Insulallon or decking.
D Poat and Beam - Prior to floor
Insulallon or decking.
D Floor Insulation - Prior to
decking.
;[] ~ltary Sewer - Prior to filling
~~Ch.
D Storm Sewer - Prior to filling
trench.
r.-,D~ ater Line - Prior to filling
~~nch.
\
O Rough PlumbIng - Prior 10
cover.
REQUIRED INSPECTIONS
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.
D Framing - Prior to cover.
D Wall/C"alllng Insulation - Prior to
cover.
D Drywall - Prior to taping.
D Wood Stovo - After Installation.
D Insert - After fireplace approval
and Installation of unit.
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
D Fence - When cOinpleted.
O S.r... Tr... - When all requIred
treea are planted.
D Final Plumbing - When all
plumbing w9rk Is complets.
D Final Electrical -- When all
electrical work Is complete.
D Final Mechanical .- When all
mechanical work Is complete.
D Final Building - When all
required Inspections have been
approved and building Is
completed.
DOther
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.
o Final - After ell required
InlllOQIIQIII lit apJlIQ...o 1II1l
porohosh.klrtlng, deOke, end
.enllno a.e .been Ineta leel,
,-
Lot faces
Lot sq. fig.
Lot coverage
Topography
Total height
BUILDING PERliiuT
ITEM
SQ. FT.
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Tolal Fee
Lot l'ipe .
Interior
Corner
\
Panhandle
Cul-de.sac
'~
X $/SQ, FT, _
(A)
',' " ((: : :.;~ " , .
'( eTHEPROPOSED WORK IN THE. .
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this appllcallon must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
Setbacks
I P.L. HSE GAR ACC
1:!...__..___
S
I
WT
-- -----
I E I I 1
VALUE
'.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanitary S!3wer FT J'lu
Water FT. /5 c)
Storm Sewer FT.
Mobile Home
Plumbing Permit
Slate Surcharge
Total Charge
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
(C)
Dryer Vent
Wood StovellnserllFlreplace Unit
N'
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
fI
Curbcut
fI
Demolition
Slate Surcharge
Total MlscellaneousPermlls (E)
TOTAL AMOUNT DU!' (excluding electrical)
(A, B, C. 0, and E Combined)
FEE
'"
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ru .
'f,iJu, 2.'fP
q'/;.{D
APPROVED:
BUILDING VALclE,PLAN CHECK
AND BUILDING PERMIT
This permllls granted on the express condition that lhe 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
oulldings, 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
By signature, I stale and agree, that I have carefully examined
the completed application and do hereby cerllfy 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 Ordlnanc~s 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 without permission of the Building Safely 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 la located at the front
of the property, and the approved set of plans will remain
on the site at all times during construction.
Signature ~ ~#//-....
Date
VALIDATION:
RECEIPT NUMBER ~ 5 ]J7 7
'DATE PAID c( / zi f)' 'I
AMOUNT RECEIVED r;,bJ ~.t/
RECEIVED BY ~