HomeMy WebLinkAboutPermit Plumbing 1991-3-25 (2)
RESIDENTIAL
PERMIT APPLICATION
e.
.- 6Ft. C'
. JOB NUMBER' ~0V
.~ 225 Fifth Streetc\\Dd--lo8-
~J/ , Springfield, Oregon 97477
~~
\\ T,AX LOl' -D ;n~ \ ~
Inspections: 726-3769
Office: 726,3759
LOCATION OF PROPOSED WORK' lJ,Bl\-"\
~SSESSORS .ry1AP' \ '1 D'A, 1\4 1-
OWNER.I ~p\(). I~ )1\C1l\\q jf\r\nt.
ADDR~~"', ~o 44- \_bo\~ .
CITY: ~/ . () STATE:
, \ \ .
~~. \lllQ i
LOT:
v
DESCRIBE WORt<.
NEW
REMODEL
ADDITION
CONTRACTOR'S NAME
BLOCI<"
~;tJ
DEMOLISH
OTHER
SUBDIVISION'
PHONF'
ZIP:
qr4-l~
ADDRESS
-----
f
CONST.
CONTRACTOR #
PHONE
GENERA' '
, PLUMBING:0. R D~l[UJ$tflcLaD
MECHANICAl'
ELECTRICAl'
QUAD AREA:
~4~D
# OF BLDGS:
OCCY GROUP'
# OF STORIES:
WATER HEATER'
~D ro. S\\6E.
J
- OFFICE USE -
LAND USE:
\ \\ ,
EXPIRES
~~<\'L~~/ql14I~'
FLOOD PLAIN'
ZONING CODE:
# OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE:
To request an Inspection, you must cal/ 726,3769, This Is a 24 hour recording, AI/Inspections requested before 7:00 a.m. wll/ be
made the same workIng day, Inspections requested after 7:00 a.m. will be made the following work day.
D Temporary Electric
D.Site Inspection - To be made
after excavation, but prior to
setting forms.
D
Underslab Plumbing I Electricall
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
o
Masonry - Steel location, bond'
beams, grou'ting.
o Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
D Underfloor Plumbing/Mechanical
- Prior ~o Insulation or decking.
D
Post and Beam - Prior to floor
Insulation or decking.
o Floor Insulation - Prior to
decking.
D Sanitary Sewer - Prior to filling
trench.
.1'if)Sto'rm s~~e~ ~ ~~;o~ ~o fj;lin~
(' trench.
o Water Line - Prior to filling
. trench.
D Rough Plumbing - Prior to "
cover.
# OF UNIT'"
CONSTR. TYPE:
HEAT SOURCE:
RANGF'
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,
D
Fireplace - Prior to facing
materials and fr?-mlng Insp.
D
Framing - Prior to cover.
D Wall/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping,
. .,.
D Wood .Stove -:. After Installation.
D 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
.and su~.base material in place.
D Fence'~ 'When completed.
o Street)"rees ....; Wh~en all requln3d" ..
trees are planted. .
D
Final Plumbing - When all
plumbing work Is complete.
D Final Electrical - When all
electrical ,,",:,ork is complete.
D Final Mechanical - When all
mechanical work Is complete.
D Final Building - When all
required Inspections have been
approved and. building is
completed.
DOther
MOBILE HOME INSPECTIONS
D Blocking and Set-Up - When all
blocking Is complete.
D Plumbing Connections - Whe!1
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, skl'rting, decks, and
venting have been Installed.
.
Lot faces Lot TYP.. Setbacks .tHE PROPOSED WOR'K IN THE
I PL. HSE GAR .ACC I' HISTORICAL DISTRICT, OR ON
Lot sq, ltg, Interior IN I THE HISTORICAL REGISTER?
Lot coverage Corner If yes, this application must be signed
Is 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 SO, FT. X $/SO. FT.
VALUE
BUILDING VALUE, PLAN CHECK
AND. BUILDING PERMIT
Main
This permi,t 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 v.iC?latlon of any provision::> of s~.id ordinances.
Garage
-Carport
Plan Check Fee:
Date Paid:
Total Val us
Receipt Number'
Buil~ing Permit Fee
State Surcharge
Received By:
Total Fee \ (A)
SYSTEMS DEVELOPMENT CHARGE (SDe)
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
FEE
(
(
,
,.!) 5 ,cO
Plumbing Permit
Total Charge
(C)
{.f)5
Bra.AS
State Surcharge
MECHANICAL PERMIT
Furnace
Vent Fan
N'
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 co~rect, 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 de"scrlbed
herein, and that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
l. further. certify that only 'contractors and employees who
are in compliance with ORS 701.055 will be used on this
project.
Exhaust Hood
Wood Stove/lnsertl Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
TOTAL AMOUNT OUE (excluding electrical)
(A, B. C, I?, and E Combined).
A( n. qs
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 timesiduring construction.
.:::':~~'0J
~ !
i'
.1
. VALIDATION:
RECEIPT NUMBER i /9Cf57
DATEPAID ,~-~S.q ~
AMOUNT R.ECE~~. 8Lo. ~--5
RECEIVED ,BY <.. l'{~ .J
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)