HomeMy WebLinkAboutPermit Building 1992-4-10
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726,3769
Ollice: 726,3759
.
SPRINGFIELD
LOCATION OF PROPOSED WORK: _~ 5" P~cRt::::I5~ ~
ASSESSORS MAP' 1,7 .b"3--'2~-'1"/
LOT:
BLOCK:
OWNER:_t...48-'f-,-I ,(fErry- 1~2?EH;~~
ADDRESS: ~~#/We: .
CITY' 4"?~ STATE: ~
DESCRIBE WORK: ~z:y 7~/.V- ~
NEW REMODEL ADDITION Y
C;~-;""..c::- J
- ,
DEMOLISH OTHER
CONST,
CONTRACTOR N
CONTRACTOR'S NAME ADDRESS
GENERAL: _t::P/A/J"Ve~
pLUMBING:vI~~ ;V~~T/~
MECHANICII I .
ELECTRICAL: k 7?E"~~
QUAD AREA: gJ0lD
. OF BLDGS:_\
OCCY GflOUP: --,E-.~
N OF STORIES:
WATER HEATER:
- OFFICE USE -
LAND USE: \ \ \ \
N OF UNITS: ) I ^ I
CONSTR. TYPE: Ji.Jv
HEAT SOURCE: ,~~ L'<::.4'-
RANG'"
.
JOB NUMBER
9=<~~?9
225 Fifth Slreet
Springfield, Oregon 97477
TAX LOT:
LJY--:::-~
SUBDIVISION'
PHON'"
"7 C/:/- S?:::/~
ZIP'
471'7:;' ?
EXPIRES
PHONE
FLOOD PLAIN: .:;)
ZONING CODE: W0
N OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE: ~
To request an inspection, you must call 726.3769. This Is a 24 hour recording. AI/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
"K::/( Site Inspection - To be made
~flcr excavation, but prior to
selling forms. :5<ST.b'IC,K
o Underslab Plumbing/Electrlcall
Mechanical - Prior to cover.
l'9r Footing - After trenches are
~ excavated.
o Masonry - ~tcel location, bond
beams, grouting.
J'9( Foundation - Afler forms are
~erected but prior to concrete
placement.
I I Underground Plumbing - Prlor
to filling trench.
'l"71' Underlloc(f'PIllj11blnQ'1.:ll.lechanlcal
~_ Prior 10 ins'urallon or decking.
"'F;Zf Post and Beam - Prior to floor
~nsulalion or decking.
K71' Floor Insulation - Prior to
).6.l decking,
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench.
o Water Line - Prior to filling
trench. '
TV( Rough Plumbing - Prior to
~cover.
REQUIRED INSPECTIONS
~ Rough. Mechanical - Prior to
~ cover.
~ 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.
~Framln9 - Prior 10 cover.
l"';z( Wail/Ceiling Insulation - Prior to
pcover.
~DrYWall - Prior to taping.
o Wood Stove - After Installation.
o Insert - Alter fireplace approval
and Installation of unit.
o
Curbcut & Approach - Arter
forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation is complete, forms
and sub.base material In place.
o Fence - When completed.
o Street Trees - When all required
trees are planted. '.
K7f' Final Plumbing - When all
~plumbing work is complete.
""fV1' Final Electrical - When all
~electrical work is complete.
~ Final Mechanical - When all
r-="meChanlcal work is complete.
~ Final Building - When all
y:::s,. 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 10
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
inspections are approved and
porches, skirting, decks, and
venting have been installed.
Lot faces
Lot Type.
LOI sq. ftg,
Interior
Lot coverage
Corner
Topography
Total height
Panl1andle
Cui-de-sac
BUILDING PERMIT
ITEM SQ, FT. X $/SQ. FT,
Main
Garage
Carport
.S THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes. this applicallon must be signed
and approved by the Historical
Coordinator prior to permit issuance.
Setbacks
, I
PL. HSE GAR ACC
N
----
~---
W
----
-L-___
APPROVE!'>'
VALUE
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on 01e express condition Ihat 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: ~3:-S"::::;;:
Dale paid:?-50-1'2-
Receipl Number: ~
:ecei~~y~
PI;lI~~WCd By
3'?. ~ /?6O=>_ <.-
/IPP- ytlZ :;17
Total Value
Building Permit Fee
State Surcharge
Total Fcc
(A)
-/-2-8:50
L3i0
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) .Jd.(:J.J?2.-
PLUMBING PERMIT
ITEM
Fixtures
.::s'
Residcnlial Bath(s)
N'
Sanitary Sewer
FT.
Water
FT.
Storm Sewer
FT.
Mobile Horne
Plumbing Permit
Stale Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stovellnserll Fireplace Unit
Dryer Vent
Mechanical Permit
fi?llJ
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
Stato Surcharge
Sidewalk
fl
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D. and E Combined)
FEE
""VI ~
V) 00
/. 5'0
3/ ,S"a
/5.~
/ D.o.o
.7>
;25.7-:
J9Q/S
,A /9,~~
77 D-~'(c-/
Systems Development Charge is due on .111 undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
~~_~_~Lr /5
.~--
lPnfh 1
By signature, I state and agree. that I have carefully examined
the completed application and do hereby certify Ihat all
information hereon is true and correct, and I rurlller certHy
that any and all work performed shall be done in accordance
with the Ordinances of the City of Sprinuficld. find Ihe Lflw:~
of the State of Orenon pcrtnlning 10 the work dC5cribed
herein, and thot NO OCCUPANCY will be made of :lny
structure without permission of the Building Safety Division.
I further certify 1t1at only contractors and employees who
are In compliance with GRS 701.055 will be used on this
project.
I further agree to ensure thai all required inspections arc
requested at the proper time, that each address is readable
from the street, that the permit card is located at tt1e front
of the property, and the approved set of plans wilt remain
on the site at all times during construction.
"Xignature';&Jt(l ~'{A)a~
Dale 4-- ( ()- q rl...
VALIDATION:
___12'5'(___ .---
--(//C)~'2, __
-r-: , I~
fJ~
RECEIPT NUMBEfl_
DATE PAID
AMOUNT RECEIVED
RECEiVED BY
,. -. r