HomeMy WebLinkAboutPermit Building 1999-8-4
RESIDENTIAL
PERMIT APPLICATION
'Inspections: 726-3769 /~I!""~~
Office: 726-3759 ~_J,I
LOCATION OF PROPOSED WORK: ,~;5rx~'\)().\S\\ ~~d,
ASSESSORS MAP: 110'2- J J J t.{ ,
OWNER' \~Q \-' \' C\ \ \ e.~,
ADDRESS:' 5\ ~ f\ ,~~ \ ,C:t" \~\
CITY ~f'~""\.c~p.. \ ~
DESCRIBE WORK:i'f\~~\\ ~~V\. \-. \~
NEW REMODEL' 'ADDITION X-'
, r,-
.
LOT:
l. t
I":", :.;t,,:
CONTRACTOR'S NAME
GENERAl.
PLUMBINf~'
e
SPRINGFIELD
~\
9~/()'rJ
225 Fifth Street
Springfield, Oregon 97477
JOB NUMBER
C\~\.\ '\ <K
TAX LOT: () f./ b t 7
BLOCK:
SUBDIVISION'
-,
PHONE: (S'-\\')'\d-,lo- {)'d,cllD
- r.-/ "
STATE:
OR,
ZIP:
Q1~ fl ~
~Y" ~,^\AQo. (:l\-v...JV ~ ~~A 0
- . -
DEMOLISH
OTHER
ADDRESS
CONST.
CONTRACTOR #
,
EXPIRES ,~ PHONE
MECHANICAL:
ELECTRICAL:
\j,'t)'N\\', 0n""\-~,\- '\\Jlo. ~-N'\ '1lll, t')>,teJ'l
3l{S.. ~&3,'6
~'-\\ ~'\
\i \ C>C)
: . . S y'OU 11.!
, -rTEN'[H;)I\I:ureguli 1c1liv ,~q~l\e UtOFFICE USE -
fl."" t dbytheOregon \IllY ~DIf\.\"ii"afi"\rc:.
QUAD AREA: ~nll'1W rules adop e ~~f::!Brl;jset forth U"U 9 U\\,9Ib. FJ",Q~QQ PlAiN'
Notification Center. fhose rgn6}A ~~2-001- THIS PERMIT SHALL EXI-IIHE Ii- ! MewooK
# OF BLDGS: in UMn ~52-G01-1}~1~;~~~es of t ~e rui~::, 1..1, AUTHORIZI::U UNDEWfA\'t,<P~I1~ffr-l8NQl
OCCY GROUP: ..()09Q..You may 0 ~'(Note'<i\~l't~r~\1t)1m:: I:.NCEDORI~A<a~~F0R
calling the center. '. ... 1\\ tification OOMM
# OF STORIES: l.J fJrtr." ("aregon Utt!llS'A'T"CS'o) lJR'CE: l(i;iYlauOAYPERI~CONl)ARY HEAT:
nUHI Cl '-. -1-800-332-2344 . I
WATER HEATER: Centens RANGE:SQUARE FOOTAGE:
To request an Inspection, you must call 726-3769. This Is a 24 hour recording. AII'nspectlons 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 mado
after excavation, but prior to
setting forms.
D Underslab Plumbingl Electrical/
Mechanical - Prior to cover.
o Footing - After trenches are
excavated. '
D Masonry - Steel location, bond
beams, grouting. ..
D Foundation - After forms are
erected, but, prior to 'concrete
placement.
o Underground Plumbing - Prior
to filling trench.
, ,
O UnderUoor P!umblng!Mech::nlcal
- Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or deckIng."
o Floor Insulation - Prior to
decking.
D Sanitary Sewer - Prior to filling
trench. ' ,
D Storm Sewer --. Prior to mllng
trench. '
D Water Line - P.rlor to filling
trench. '
....
D Rough Plumblng,-, Prior to
cover. \. '
I
'I
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
Final Plumbing - When all
bing w~HI< Is complet,e.
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 Final Building - When all
required Inspections have been
approved and building Is
completed.
D Framing - Prior to cover. .
~ . ,,~ ,
D Other
o Wail/Ceiling Insulatlon..-'- ~rlor to
cover.
o Drywall- Prior to ta~l,ng.
MOBILE HOME INSPECTIONS
D Wood Stovo - After Installation.
o Insert - After fireplace approval
and Installation of unit.
o Blocking and Set.Up - When all
blocking Is complete.
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Plumbing Connections - When
home has been connected to
water and sewer.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
o Electrical Connection - When
blocking, set.up, and plumbing
Inspections have been approved
and the home Is connected to
the service panel.
o Fence - When cOf,'pleted.
o ,Street Trees - When all required
trees are planted.
D Final - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
.
.
Lot'~y.
Interior
Lot faces
, ,
Lot sq. ftg. ,
"
Lot coverage
Corner
Topography
Total height
1,'
Panhandle'
Cul.de'sac
:-.'
BUILDING PERn)1IT 'ii,
ITEM SQ. FT.
.'~:
, {~
'~
X $/SQ. FT, =
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
',: ':,. ..~., ~,' ;.,' 'l;:' .
.","
ii'j\,;t;~:~ '
.IS THE PROPOSED WORK tN THE.
'HISTORICAL DiStRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this appllclltlon must be signed
and approved ,by the Historical
Coordinator prior to permit Issuance.
'., .~
Setbacks .
P.L. HSE GAR ACC
N
S
w
IE
APPROVED: '
1_.__--'
VALUE
, '" '''1 "I
BUILDING VALdE, 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, 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:
Date Paid:
Receipt Number'
Received By: '
Plans Roviewed By
Date
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING, PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary S~wer
Water
FT.
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
-
Wood Stovellnsert/Flreplace Unit
Vnta~
,
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile 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)
Systel1,1s Development Charge Is due on all undeveloped
properties within the City limits which are being improved.
FEE
ADDITIONAL CpMME"pITS
cC f::Z.7,(r ~ /'I'l.~~/
, .
/)'.. 00
IIJ.07J
l~otJ
,t.W
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 perlalnlng to the work described
herein, and that NO OCCUPANCY will be made of any
structure 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.
l
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 d '~S~.
Signature ~/ M ~ , ~
'~
Date
~.
VALIDATION:
RECEIPT NUMBER t) ~:> II 0
({/4/0,1
AMOUNT RECEIVED 1/'2.. h. 5'J?l
tLtLJ~
DATE PAID
RECEIVED BY