HomeMy WebLinkAboutPermit Plumbing 1999-4-2
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726.3759 _rg
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LOCATION OF PROPOSED WO'~R:SHALLEX~~T1IEWOR~ T
ASSESSORS MAP' i % IJ 2-'-O"3:Z\I~F.<" THIS PERMIT IS NOT
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LOT: BLOCK'
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OWNER'
ADDRESS:
CITY:
DESCRIBE WORI<'
NEW
REMODEL
CONTRACTOR'S NAME
(;~
GENERA' .
PLUMBIN'"
MECHANICAl'
ELECTRICAl'
QUAD AREA:
. OF BLDGS'
OCCY GROUP'
. OF STORIES:
WATER HEATER:
-
qq 0 l(J('
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
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TAX LOT: ....f2....4C 00
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
D Rough Electrical - Prior to
cover.
D Electrical Service - Must be
epproved to obtain permanent
electrical power,
D Fireplace - Prior to taclng
materials and framing Insp.
D Framing - Prior to cover.
D Wail/Ceiling 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 - Afler
excavation Is complete. forms
and sub.base material In place.
D Fence - Woen cori'\pleted.
D Street Trees - When all required
trees are planted.
SUBDIVISION:
PHONF'
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STAT'" .
OIL-
ZIP:...!L.7 '-r 7 Y
EXPIRES ~ PHONE
7U ZI 7/
FLOOD PLAIN'
ZONING CODF'
. OF BDRMS'
SECONDARY HEAl:
SQUARE FOOTAGE:
To request an Inspection, you must call 726-3769. This Is 8 24 hour recording. All Inspections requested before 7:00 8.m, will be
made the same working day, Inspections requested aller 7:00 a.m. will be made the following work day.
D Temporary Electric
D Site Inspection - To be mado
after excavation. but prior to
setting torms,
D Underslab Plumblng/Electrlcall
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
D Masonry - Steel location, bond
beams, grouting.
D Foundation - After forms are
erected. but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D Undeflloor Plumbing/Mechanical
- Prior to Insulation or decking.
D POBt and Beam - Prior to floor
Insulation or decking.
D Floor Insulation - Prior to
decking.
b ~ltary Sewer - Prior to filling
~~Ch.
D Storm Sewer - Prior to filling
trench.
TI---:Jater Line - Prior to filling
~enCh.
D Rough Plumbing - Prior to
cover.
ADDITION
DEMOLISH
OTHER
ADDRESS
WI0;;~
CONST,
CONTRACTOR .
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"' ""t_, ),"onnn lAW reaLIITeS you to
1-..11'-....-.- - oonUtllllY
follow rules adopted by the ,_ ~e~__ M' Inrlh
Notification Center. I flU"" ,vh'vO~ Ai:>.- 952-001-
_ ..... ""'...,.. ntH _nn1nthrOUQ
'\ I Uf"'\1 ~ :---~- ~:... ....'"'+~in rnnies of the rUle~ uy
vvov. ......... ..._-" ... -......^+elepnon~
calling the cer';"JOi'lF.ICE. USE'- T r n
number fnr lol'! Oregon Utility Notl Ica 10
L:ft..ND USI=.. _.....f" ....,," I')'JAA\
l,;enter lb 1 -vv.... --- - .
. OF UNITS'
CONSTR. TYPE:
HEAT SOURCE:
RANG'"
D Final Plumbing - When sll
plumbing W9rk Is complet~.
D Final Eloctrlcal - When all
electrical work Is complete.
D Final Mechanical '- When all
mechanical work la 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,
D Final - After sll required
Inspections sre approved and
porchos, skirting, decks, and
venting have been Inatalled,
Lot faces
Lot Type
Inlerlor
Lot sq. ftg.
Lot coverage
Corner
Panhandle \
Topography
Total height
Cul.de-sac
BUILDING PERMIT
ITEM SO. FT.
t
X $/SO. FT. =
Main
Garage
Carport
Total Value
Bul'dlng Permit Fee
State Surcharge
Tolal Fcc
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanitary S~wer FT. It-tJ
Water FT. /$ r)
Storm Sewer FT.
Mobile Home
Plumbing Permit
Slate Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
N'
Wood Stovellnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
Stale Surcharge
Sidewalk
It
It
Curbcut
Demolition
State Surcharge
Tolal Miscellaneous Permits (E)
TOTAL AMOUNT DU!' (excluding electrical)
(A, B, C, D, and E Combined)
,1','::;,;;":'
.S THE PROPOSED WORK tN THE _
'''HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
II yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
Setbacks
P.L. HSE GAR ACC
S
IN -1
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BUILDING VALl'JE, PLAN CHECK
AND BUILDING PERMIT
N
VALUE
"
FEE
Cv
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APPROVED:
This permit is 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
Dovelopment 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:
Date Paid:
Recel pi Number'
Received By:
Plans Reviewed By
Date
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 h'ave 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 Ordinanc~s of the City of Springfield, end the Laws
of the State of Oregon pertaining to the work described
herein, and thai NO OCCUPANCY will be made of any
struclure without permission of 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.
Signature ~;' ~...e-A"#".A? ./
Dato
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
RECEIVED BY _
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