HomeMy WebLinkAboutPermit Plumbing 1997-9-8 (2)
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
.
SPRINGFIELD
I."
LOCATION OF PROPOSED WORKj (\tl\
ASSESSORS MAP: \1tl~"J,/\lX'r
LOT' ,~
~~~}I\\'t~ ~ C'v
9-.~r() W"~1\\1 Q (\lHL
~A~\\O _ ' ~ STATE:~
DESCRIBE WORK: \} ~ f\_~ I f\Q ~
OWNER:
ADDRESS'
CITY'
NEW
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERAl'
PLUMBING: ~(\~"S
MECHANIC' I .
ELECTRICAl'
QUAD ARE..'
. OF BLDGS:
OCCY GROUP'
. OF STORIES:
WATER HEATER'
D Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o UnderslAb Plumbing/Electrical/
Mechanical - PrIor to cover.
D Footing - After trenches are
excavated.
D Masonry - Steel locatlon, bond
beams, grouting.
D Foundatlon - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
, to filling trench,
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Post and Boam - Prior to floor
Insulation or decking.
D Floor Insulation - Prior to
deckl ng,
o Sanitary Sewer - Prior to flltlng
trench.
D Storm Sewor - Prior to tilling
trench. t f
, .
~aler Line - Prior to filling
. trench. ~... . ..
D Rough Plumbing :- Prior. to
cover.
BLOCK'
DEMOLISH
OTHER
.
()~~~
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
ZIP: U.~\
ADDRESS
CON ST.
CONTRACTOR'
EXPIRES ~. PHONE
'~I f<\h_~
\ 0 \lo'lA-
- OFFICE U~
1:. ~
LAND USE: '>>n_ 1'~
.y~ t.,o ,.
. OF UNITS:_"'- ~- ~-91"
,V4,; 0-5) -"I'
CONSTR. T~ ~'" ~~_ <l'..y
'1. "/le 'V,"'t(.
HEAT SOURCE: O'O.,? ~ /~ ( ~-I-,... SECONDARY HEAT:
"1)- V-9 '$' "r-5)
'of';>y, /,~ J'~cS' ~~QUARE FOOTAGE:
V,., 19~ .0" )).
'V "/I; ,~' T~.
To request an Inspection, you must call 726.3769. This Is a 24 hour recording. All ~p,e{~)'s ~ested belore 7:00 a.m. will be
made the same working day, Inspections requested after 7:00 a.m. will be made thj(~~WWJh~ day.
REQUIRED INSPECTIONS .0-9 OJ'
RANGE: _
D Rough Mechanical - Prior to
cover.
o Rough Electrical - Prior to
cover.
D ElectrIcal Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to 'acing
materials and framIng Insp.
D Framing - Prior to cover.
D Wall/C'elllng Insulation - Prior to
cover.
D Drywall - Prior to taping.
o Wood Stovo - After Installation.
o Insert - After fireplace approv41
. and Installation of unit.
D Curbcut & Approach - After
forms are erected but prior to
placemont of concrete.
D Sidewalk & Driveway - After
excavation Is compietc, forms
and sub-base material In place.
D Fence - VVhen completed.
o Street Treos - When all required
trees are planted.
8.l~ q<i(
FLOOD PLAIN'
ZONING CODE:_
. OF BDRMS'
D Final Plumbing - When all
plumbing w9rl< Is eomplet,e.
o Final ElectrIcal - When all
electrical work Is complete.
o Final MechDnlcal - When all
mechanical work Is complete.
D Final Building - When all
required Inspections have been
approved and building Is
completed.
DOthor
MOBILE HOME INSPECTIONS
D Blocking and Set,Up - When all
blocking Is complete.
D Plumbing Connections - When
home has been connected to
water and sewer.
D 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 Type.
Lot sq. !tg.
Lot coverage
Interior
Corner
Topography
Total height
Panhandle
Cul-de.sac
BUILDING PERMIT
ITEM sa. FT. x $/sa. FT.
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fcc
(A)
.....
.,
~ THE PROPOSEO WORK iN THE.
HISTORICAL OISTRlcr, OR ON
THE HISTORICAL REGISTER?
II yes, this application must be signed
and approved by the Historical
Coordinator prior to' permit Issuance.
Setbacks
I P.L. HSE GAR ACC
IN
Is
Iw I
lLL,
VALUE
"
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Resldenlial Bath(s)
N'
Sanitary S~wer
Water
FT.
FT.rM~\J
Storm Sewer
FT.
Mobile Home
c.
.t.
.~ I'
.',. ...
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
N'
Wood Stovellnserl/ Fireplace Unll
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
II
Curbcut
Demolition
State Surchargll
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
FEE .;\
,
.:.
. L\b pY'.,{
~.~-
4"3.:10
~
APPROVEP' '
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 su.spended or revoked at any lime
upon violation of any provisions of said ordinances.
Plan Check Fee:
Date Paid:
Receipt Number'
Received By:
Plans Rovlewed By
Date
Systems Development Charge Is duo on all undeveloped
properties within the City limits which arc being Improved,
ADDITIONAL COMMENTS
..
By signature, I stato 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 thai 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 lo 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.
Slgnatur::fl.J&..
~j ~ t/
.
Date
< -
VALIDATION:
RECEIPT NUMBER_
;::;T"\'" -
-. :
".~0?l~(
C\ -15 .Cj1~
DATE PAID _
AMOUNT RECEIEh ~ ~. ~()
RECEIVED BY LlO-J