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HomeMy WebLinkAboutPermit Miscellaneous 1991-5-6 - r~ " , RESIDENTIAL PERMIT APPLICATION , SPRINGFIELD Inspections: 726-3769 Office: 726-3759 LOCATION OF PROPOSED WORK: ~8 \ \ 0 , ASSESSORS MAP" \1 () ~~\O \ " 0WNER:~9~\~C\.. ,\\"'''\\''\\y.- ADDRESS: A~ \ \.9. \::\ Q. D \. (') . \ \\ \~ n 'f> ,f" ~ CITY:~ ~ ~ STATE: l~ DESCRI BE WORK\ ^ ~ ~\ () f{\ Q. . \ 0\ \: ~ ~ \. J.. t\(L) REMODEL \ ADDITION . LOT: NEW CONTRACTOR'S NAME BLOCK: DEMOLISH OTHER 1- S\~~ JOB NUMBER 225 Fifth Street Springfield, Oregon 97477 l \)5\"U-R. , TAX LOT: SUBDIVISION' () \C\ ex.) PHONE: ,A\{)-<\~l Q~ () ZIP: q141r ADDRESS CON ST. CONTRACTOR # PHONE EXPIRES GENERAl' .J,_ . "^,, PLUMBING: ('f\~~Q\J~IS\~0\\:) ~~\m2,~~-n.ruJ;1lVl<A J().~ 141-\CP[) MECHANICAl' ~~~ \ Q/?lfa.l ELECTRICAl' QUAD AREA: c9 ~~ lh) # OF BLDGS: ~~ OCCY GROUP' # OF STORIES: WATER HEATER' - OFFICE USE - LAND USE:-U-LI # OF UNITS: CONSTR. TYPE: HEAT ~OURCE: RANGF' 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 o Site Inspection - To be made after excavation, but prior to settlng forms. o Underslab Plumbing! Electrical f 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 Underfloor Plumbing/Mechanical - Prior to Insulation or decking. o Post and Beam - Prior to floor Insulation or decking. o Floor Insulation - Prior to decking. o Sanitary Sewer - Prior to filling trench. . o Storm Sewer - Prior to filling trench. \~ Water Line - Prior to filling ~ trench. G Rough Plumbing - P~ior to cover. REQUIRED INSPECTIONS o Rough Mechanical - Prior to cover. D Rough Electrical - Prior to cover. , o Electrical Service - Must be approved to obtain permanent electrical power. o Fireplace - Prior to facing materials al)d framing Insp. o Framing - Prior to cover. o Wall/Ceiling Insulation - Prior to cover, o Drywall - Prior to taping. o Wood Stove - After Installation. o Insert - After fireplace approval and Installation of unit. D Curbcut & Approach - After forms are erected but prior to placement of concrete, o Sidewalk & Driveway - After excavation is complete, forms ~nd sub-base material in place. o Fence - When completed. o Street Trees - When all required trees are planted. o Final Plumbing - When all plumbing work is complete. D Final Electrical - When all electrical work is complete. o Final Mechanical - When all mechanical work is complete. o Final Building - When all required Inspections have been approved and building is completed. o Other MOBILE HOME INSPECTIONS 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. o Final - After all required In.spectlons are approved and porches, skirting, decks, and venting have been Installed. l Lot Type I , ~ l Lot faces Setbacks IS THE PROPOSED WORK IN THE I P.L. , , , I HISTORICAL DISTRICT, OR ON Lot sq. ftg. Interior HSE GAR ACC I THE HISTORICAL REGISTER? Lot coverage Corner N If yes, this application must be signed S I and approved by the Historical Topography Panhandle Iw I Coordinator prior to permit issuance. Total height Cul.de.sac IE I APPROVED: BUILDING PERMIT iTEM SQ. FT. X $/SQ, FT. Main Garage Carport Total Val ue Building Permit Fee State Surcharge Total Fee (A) SYSTEMS DEVELOPMENT CHARGE (SDC) Systems Development Charge Is due on all undeveloped properties within the City limits which are being improved. (B) PLUMBING PERMIT ITEM Fixtures Residential Bath(s) N' Sanitary Sewer FT. FT. Water Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Fu mace Exhaust Hood Vent Fan N' Wood StoveJlnsertlFireplace Unit Dryer Vent Mechanical Permit Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk ft Cu rbcut ft Demolition State Surcharge Total Miscellaneous Permits (E) / TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) VALUE 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 ordinances. Pian Check Fee: Date Paid: Receipt Number: Received By: Plans Reviewed By Date ADDITIONAL COMMENTS FEE \~"c:O ~{.J.VV ~~~ S\~ \S.CO f)~ \~.f\S 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 GRS 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 the site at all times during construction. Signaturd ~~~A) (1.1~ Date_,f :rh/9/ VALIDATION: RECEIPT NUMBER '\qG\\S ~. \0 . C\ \ tS. 'lS d( rO---' DATE PAIr> \~. fJ5 AMOUNT RECEIVEr> RECEIVED BY -, .. e , . Permit No: q \()4-~~ Address: ~?) \lo \:1ilii\oJ Issued by: Him ~ Date: bj..kicrJ FOR OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. licensed Architect and Engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the applicable blanks, and initial box 1 and either box 2A or 2B: ;~ / I own, reside in, or will reside in the completed strup,.l.\Jre. My ~~contractor is \\n N\S::DO~~ ~ V~, Contractor registration number LD I); () \ R , I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board, OR B. L-.J I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and (to hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board and I will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and understand the Information Notice to Property Owners about Construction Responsibilitiell on the reverse side of this form. ni .JL7Ao) (V / ,tA~ siqnature of Permit Ap'Bc'ant ,.5--&- 9/ Date CONSTRUCTION CONTRACTORS BOARD 0244J 1/90 fljJP · , " t: COpy TO ISSUING AGENCY PERMIT FilE ~py TO APPLICANT ""