HomeMy WebLinkAboutPermit Building 1991-5-15
RESIDENTIAL
PERMIT APPLICATION,
Inspections: 726:3769
Office: 726.3759
LOCATION OF P~OPO~D~~' ~?-; '35
ASSE~_$()R9. M..AP' \ ~ 1Lt}. 5~,",
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SPRINGFIELD
.
0(1[)4q1J
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
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TAX LOT: fl , S~
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"..:... .... .~., ,.,.', -,:>Ooq"'
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LOT:
"
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:. BLOCK:
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OWNER '-4W(,..H\t'Ll\Q '.'~. ..
. Q~. _~. . STATE: _~ ~6
DESCRIBE WOR . <oh, If\t\KL . LO\c\ LU "'\ r 1-\ \l~_l-t
NEW REMODEL" ~DITION . DEMOLISH OTHER
CITY:
SUBDIVISION:
1
PHON E:
ZIP: C\ F4-e
CONST.
. ~~O;r,)' ' ~\f\\ ~~~C~O~ #
(\~ \LlA -,tl~ ~,H , \\
CONTRACTOR'S N~ME
GENERA,t ~ I~ ~
PLUM~ING:~Q MiA
MECHANICAL: A_ C,J
E.LECTRICAL: lV C{\O t>J
I.. . . t ." '.. .. ~ ~
, '
~
QUAD AREA: (~~~
. \
OCCY GROUP: R~
\
T',
# OF BLDGS:
# OF STORIES:
WATER HEATER:
'f
"-- OFFICE USE -
\\ 7!n
(
LAND USE:
# OF UNITS:
CONSTR. TYPE:
HEAT SOURCI=' ~~
iBANGE: ~.
EXPIRES
PHONE
1'\1,,- lltj3
"
If
"
.. "- . . ~. '
FLOOD PLAIN'
ZONING CODE:
lD~'
. . I
# 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 S,ite Insp.ection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumbing/Elec~rical/
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.
o Underfloor Plumbing/ Mechanical
~ Prior to insulation. or decking.
D
Post and Beam - Prior to floor
insulation or decking.
D Floor Insulation - Prior to
decki ng.
D Sanitary Sewer - Prior to filling
trench.
".. " ". . .
D Sto'rm Sewer - Prior to filling
trench. .
D Water Line - Prior to filling
trench.
D Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cove~ '
, 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/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
...... -'"
D Wood Stove - After installation.
D Insert - After fireplace approval
and installation of unit.
,
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
0' Sidewalk. & Driveway - After
excavation is compiete, forms
and sub-base material in place.
-' . - .
o Fence :"':When completed.
D Stree.t'Trees -: vilhoe,;'all'requi'r'ea
trees are planted.
. '
D
Final Plumbing - When all
plumbing work is~complete.
.' . . .
D Final Electrical - When all
elect~i~al 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.
D Other
MOBILE HOME INSPECTIONS
~;' "
ocking and Set-Up - When all
ocking is complete.
Plumbing Connections -, When
home has been connected to
water and sewer.
,
ectrical Connection - When
blocking, set-up, and plumbing
inspections have been approved'
and the home is connected tf
the s~~ ,Qqo\'
inal - After all required
inspections are approved and'
porches, ski rling, decks, and
venting have, been install.ed.
,
. I
.' , . " ., THE PROPOSED WOR~:';~ ~::
Lot faces Lot Type Setbacks "
. ' I I P.L. ACe I
Lot sq. ftg. Interior HSE GAR HISTORICAL DISTRICT, OR ON
IN I THE HISTORICAL REGISTER'?
Lot coverage Corner If yes, this application must be signed
Is I I
,
and approved by the Historical
Topography Panhandle ,I w I. I Coordinator prior to permit issuance. i\
\
Total height Cul-de-sac
IE I I
APPROVED: \
\
\
BUILDING PERMIT
ITEM sa. FT. x $/SO. FT. = VALUE
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Main
,
I
This permit is gral)ted. on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of Springfield, inclu9in9 the
Development Code, regulating the construction a'nd use of
buildings, and may be suspended or revokEld at'any time
upon violation of any provisions of said ordinantes.
Garage
Carport
Plan Check Fee'
Date Paid:
Total Value
Receipt Number'
Building Permit Fee
Received By:
State Surcharge
Total Fee
(A)
Plans Reviewed By
Date
,
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
I
properties within the City limits which are being improved.
PLUMBING PERMIT
ITEM
ADDITIONAL COMMENTS
FEE
Fixtures
Residential Bath(s)
NO
Sanitary Sewer
FT.
Water
FT.
Storm Sewer
FT.
Mobile Home
Total Charge
(C)
1S.~
)S. '75
Plumbing Permit
State Surcharge
MECHANICAL PERMIT
Furnace
Vent Fan
NO
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 d~scribed
'." 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. '
Exhaust Hood
Wood Stove/lnsert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
MISCELLANEOUS PERMITS
glcQS
11.5. ?'5
I. ') &5
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 wilf remain
on the site at all times during constru~ :
Signature 1'z.. 9- - ~d'Jz:..-~"'/
r7-/~- ~ r
Total Permit
(D)
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Date
Curbcut
ft
\.
Demolition
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D!. and E Combi,ned)
I~_ CO,
VALIDATION: .-fJ/'v'\/ _ 0'
RECEIPT NUMBER Q...LJLQC)
5'(~'~/ ~ j.
.s..... j) L/ V' ~ CO,
AMOUNTREr~'(7. ~-
RECEIVED B (111 ~
... --
DATE PAID
State Surcharge
Total Miscellaneous Permits (E)
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