HomeMy WebLinkAboutPermit Mechanical 1996-4-29
RESIDENTIAL
PERMIT APPLICATION
, Inspections: 726-3769
Office: 726.3759
LOCATION OF PROPOSED WORK: Sf\ ~
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ASSESSORS MAP:
LOT:
BLOCK:
JOB NUMBER
C\ LQD~-
225 Fifth Street
Springfield, Oregon 97477
TAX LOT:
aJ\rf.)
SUBDIVISION:
OWNE~::~ )\\\~~~Mt') ~~N\OO~ PHONE: \~~ .1L~1
ADDRE~~L n'A~~ 'f{~.()~ '[\ ,1.- . .
CITY:' \ . \. \\1.r\' .I~~ (\ - . S. TATE: .l\J).~ Nr\. \ ZIP: "-\\.. ~ l~
... "-\ . \\ - -
DESCArBEWOA~ \\~,-L0 (Y) D )bQ~Dl!'L.>~r\.l,-)tf)~ J-+&Df'.
REMODEL' . AD~'ON ' ' DEMOLISH OTHER . .
NEW
CONTRACTOR'S NAME
GENERAL'
PLUMBING: (\ /- )
MECHANICAL: (\)1~ lC)\'Q.f_
ELECTRICAL:
ADDRESS
CONST,
CONTRACTOR It
1\
PHONE
EXPIRES
- OFFICE USE -
QUAD AREA: -LAND USE: FLOOD PLAIN:
It OF BLDGS' It OF UNITS' ZONING CODE:
OCCY GROUP' CONSTR, TYPE: It OF BDRMS:
It 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
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover,
o Footing - After trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting,
o Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench,
o Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
o Post and Beam..,. Prior to floor
insulation or decking,
o Floor Insulation ;.... Prior to
deckl ng,
o Sanitary Sewer - Prior to flllln'g
trench,
o Storm Sewer - Prior to filling
trench,
o Water Line - Prior to filling.
trench,
o Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover,
o Rough Electrical - Prior to
cover,
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp,
o Framln~ - Prior to cover.
o Wail/Ceiling Insulation':"" Prior to
cover.
o Drywall - Prior to taping,
o Wood Stove - After Installation.
o Insert - After fireplace approval
. and Installation of unit.
o Curbcut & Approach - After
: forms are erected bul prior 10
, placement of concrete,
D Sidewalk & Driveway ..L After
excavation Is complete: forms
and sub-base material in place,
0, Fence - When completed,
o Street Trees..,. When all required
trees are planted.
D Final Plumbing - When all
plumbing w()rl< is complete,
o Final Electrical - When all
electrical work is complete,
D Final Mechanical - When all
mech'anical work Is complete,
D Final Building - When all
, required Inspections have been
approved and building is "'-
completed,
~er
vf{
o Blocking and ,Set-Up - When all
blocking Is complete, ,
o Plumbing Connections - When
, home has been connected to
water and sewer:
o Electrical Connection - 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 T~
Lot sq, ftg,
I P.L.
IN
Is
Iw
LE
Interior
Lot coverage
Corner
Topography
Total height
Panhandle
Cul-de-sac
BUILDING PERMIT
,
ITEM
x $/SO, FT.
SQ, FT,
VALUE
Main
Garage
"
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fec
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Resld'ential Bath(s)
NO
Sanitary S~wer
Water
... FT,
FT,
Storm Sewer
FT,
MObile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
,MECHANICAL PERMIT
Furnace
Exhaust Hood
Ven! Fan
NO
Wood Stove/lnsert/Flrep/ace Unit
~. 0, e, Ven'/-.. n 11.('(\0 ui)
I LJ ""--'l vn..... L'-'1i. r2S.
chanical' Permit ' . f.,...S .00
., !(),OU.
I ~YJ
c:::JLo '.a~)-
Issuance
State SurCharge
I ~CyU
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
t
Total Miscellaneous Permits (E) _
TOTAL AMOUNT DUE (excluding c;ectr:l)&0 .~)
(A, B, C, D, and E Combined) .
<.'-, ..' .
Setbacks '
HSE GAR ACC
- ( IS THE PROPOSED 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,
I
I
APPROVED:
'. ";.. . '.
BUILDIN'G VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall, in,all respect::;, conform to the Ordinance
adopted by the City. of Springfield, including the
Development Code, regulating the construction and use of
buildings, and may be suspellded 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 wi,thin the City limits which are being improved,
ADDITIONAL COMMENTS
Byslgnature, 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 flJrther 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, and the approved set of plans will remain
on t e site at all times during construction,
S 9 alu#1U~y kpm
VALIDATION: f\ "2..\(/
RECEI'pT NUMB~ a\0 ~O
DATE PAID ,\:""- ?J-1 GIn
AMOUNT ""C"'tJt: ~\ o:.cl)
RECEIVED BY ~fJ()' )
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