HomeMy WebLinkAboutPermit Mechanical 1997-12-16
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
ASSESSORS MAP'
LOT"
OWNER:
DESCRIBE WORK: L0 \ t..\
REMODEL'>(
NEW
CONTRACTOR'S NAME
GENERAl'
PLUMBING'
.
UG-o
.
JOB NUMBER 97 L7 3 7_
225 Fifth Street
Springfield, Oregon 97477
.
~0F' 0
BLOCK'
ADDITION
ADDRESS
CONST,
CONTRACTOR"
PHONE
EXPIRES
MECHANICAL:
ELEcTRICAl'
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SUBDIVISION: ~", '.'. . _ ....\a~
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ADDRESg,' <::..,\c:.., (\'V,f\Art..lJL ~\)~.o ~rS\~.;o..~~"::J'V,~~y"<(.. ~~",v..:'
CITY: ~\r\.. STATE: ~~Q.\I..~~'?-()<(..~(0. ZIP:~C)1-Ioo...
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DEMOLISH ~ OTHER ..J
QUAD AREA:
. OF BLDGS'
OCCY GROUP:
. OF STORIES:
WATER HEATER:
- OFFICE USE -
LAND USE:
. OF UNITS:
CONSTR, TYPE:
HEAT SOURCE:
RANGE: _
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,
D Temporary Electric
D Site Inspection - To be made
after excavation, but prIor to
setting forms.
D Underslab Plumbing/Electrical I
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
o "Masonry - Steel location, bond
beams, grouting.
D Foundation - After forms are
erected but prior to concrete
placement.
D .l!.nderground Plumbing - Prior
to fllllng trench.
D Underlloor Plumblng/Mechanlcal
- PrIor to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
D Floor Insulation - Prior to
deckl ng.
D Sanitary Sewer - Prior to filling
trench.
D Storm &ewer - PrIor to filling
trench.
D Water Line - Prior to filling
trench.
D Rough Plumbing - Prior to
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.
o Wall/C'alllng Insulation - Prior to
cover.
D Drywall - Pllor to tapIng.
D Wood Slovo - After Installation.
D Insert - After fireplace approval
and Installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sidewalk & Driveway - After
excavation Is completo, forms
and sub-base material In place.
D Fence - When completed.
D Street Trees - When all required
trees are planted.
D Final Plumbing - When all
plumbing work Is complete.
D Final Electrical - When all
electrical work Is complete.
~Inal Mechanical - When all
mechanical work Is complete.
D Final Building - Wh<tn all
required Inspections have been
approved and buildIng is
completed.
~rn-~
MOBILE HOME INSPECTIONS
D Bloeklng and Set.Up - When all
blockIng is complete.
D Plumbing Connections - When
home hos been connected to
water and sewer.
D Electrical Connecllon - When
blocking, set-up, and plumbing
inspections have been approved
and the home Is connected to
the service panel.
D Final - After all required
Inspections are approved and
porches, skIrting, decks, and
venting have been installed.
Lot faces
Lot Type.
Interior
Lot sq. ltg,
Lot coverage Corner
Topography Panhandle
Total height Cul.de.sac
BUILDING PERMIT
ITEM SO. FT. X. $/SO. FT.
Main
Garage
Carport
Total Value
Building Permit Fee
Slate Surcharge
Total Fee
(A)
. or, ;.,
.
Setbacks
I P.L. HSE GAR' ACC I
N
S
Iw
IE
VALUE
"
',','
.
tt~
,
SYSTE~S DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(';)
N'
Sanitary S~wer
Water
FT.
FT.,
Storm Sewer
FT.
Mobile Home
Plumbing Permit
Stato ,Surcharge
Total Ctlarge
(C)
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
N'
Wood Stovellnsert/Flreplace Unit
Dryer Vent
Mechanical Permi t
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolitlon
State Surehargll
Total Mlseellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrleal)
(A, B, C, D, and E Combined)
FEE
..$f IS"" l -
~ lO,
-+--7~r, lf~
.:It;.:) fa.';>~
IS THE PROPOSED WORK iN THE.
..HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
II yes, this appllealion must be signed
and approved by the Hlstorleal
Coordinator prior to permit issuance.
APPROVED'
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
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, ineludlng 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'
Date Paid:
Receipt 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 state and agree, that I have carefulry examined
the eompleted 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, and the Laws
of the State of Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be made of any
structure without permission of the Building Safe.ty Division,
I further certify that only contractors and employees who
are In eompllance 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~times during con~ellon. ~ .
f Slgna~ie\ "~X?l~,,-- Q ~- ~
-t Date Dlllo! ev)
VALIDATION:
;)8J-CC""l
1;}-11o-"I7
AMOUNT RECEIVEn ~ dr~. ~
RECEIVED BY ~t.L ")
RECEIPT NUMBER
DATE PAlf""I