HomeMy WebLinkAboutPermit Building 1996-5-31
RESIDENTIAL
PERMIT APPLICATION
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SPRINGFIELD
JOB NUMBER
Inspections: 726.3769 . .~ 225 Fifth Street
Office: 726-3759 ~11 Springfield, Oregon 97477
LOCATION OF PROPOSED ~ ,~'?"r?'r:::J \ f'{',', ~ ,~/ lL 7i)
ASSESSORS MAP: \lllJ..LD 00 - - - G TAX LOT: O\~tU
LOT- BLOCK: SUBDIVISION'
DESCRIBE WORK: 6)J"X\~tT
NEW REMODELA-D~~I~N
OWNER:
ADDRES
CITY:
CONTRACTOR'S NAME
GENERAL:
PLUMBING:
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MECHANICAL:
ELECTRICAL:
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. PHONE:
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ZIP:
STATE:
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DEMOLISH
OTHER
ADDRESS
CONST.
CONTRACTOR /I
PHONE
EXPIRES
'.
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- OFFICE USE -
QUAD AREA: LAND USF' FLOOD PLAIN:
/I OF BLDGS: /I OF UNITS: ZONING CODE:
OCCY GROUP: CONSTR. TYPE: /I OF BDRMS:
/I OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER' RANGE' 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.
o Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumbing/ Electricall
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o
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 Underfloor Plumbing/Mechanical
- Prior to Insulation or decking.
o
Post and Beam - Prior to floor
Insulation or d~cking.
'. "',
D Floor Insulation - Prior to-,
decking. ,
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench. .
,
.
o Water Line - Prior to fllllnQ _
trench. . -
. .....
D Rough Plumbing - PJlor to
cover. . '.
,
REQUIRED INSPECTIONS
/
L:::J Final Plumbing - When all
plumbing work Is complet.e.
. 0 Rough Mechanical - Prior to
cover. .
D Rough Electrical - Prior to
cover.
D Final Electrical -When all
electrical work Is complete.
D Electrical Service - Must be
approved to obtain permanent
electrical power. '
o Final Mechanical - When all
mechanical work Is complete.
o 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.
o Other
o Wail/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
. . . .
o Wood Stove - After Installation.
.,'
o Insert - After fireplace approval
and Installation of unit.
j ,
o Blocking and Set-Up - When all
blocking Is complete. '
, . 0 Gurbcut & ,Approach - After
forms are erected but prior to
placement of concrete.
o Plumbing Connectlons- When
home has been connected to
water and sewer. '
o Sidewalk & Driveway - After
, excavation Is complete, forms
and sub-base material In place.
D Electrical Connection - When
blocking, set-up, and plumbing
Inspections have been approved
and the home Is connected to
the service panel.
o Fence - When completed.
D Flnal- After all required
Inspections are 'approved a'nd
" porches', sklrtln'g, decks, and
venting have been. Installed:
o Street Trees - Whenall.requlred
trees are planted. -, . '
,
l' THE PROPOS~D WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
. Coordinator prior to permit Issuance.
Lot faces Lot Type . Setbacks
I P.L. I
Lot"sq. ftg. ' Interior HSE GAR ACC
IN
Lot coverage Corner
Is
Topography Panhandle
Total height Cul-de.sac W
E
BUILDING PERMIT
ITEM SQ. FT. X $/SQ. FT. .. VALUE
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
NO
FT.
Storm Sewer
FT.
FT.
Mobile Home
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\\Q .tD
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
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)
Uo.'U)
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, 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 'ordlnances.
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
,I
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 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.
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, n the a pr ved set of la will remain
\ 7\ the site at I tl es urln co str c
~nature" /
Oat. S/3Vi(? ~/
.
VALIDATION:
RECEIPT NUMB~ 'Z.../ 7~ "')
DATE PAID ';).~\ .Ct lJ)
AMOUNT RECE~' ED \ \1' . ~ iJ
RECEIVED BY If.1l)
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