HomeMy WebLinkAboutPermit Building 1-4-23
RESIDENTIAL
PERMIT APPLICATION
'.
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPO~~ ~ORK: . 5077 ':'/;/(7. -~<;I 1/1/4
ASSESSORS MAP: l nu ~() q (;() . , '
I
LOT: (2 BLOCK:
OWNER:
ADDRESS:
CITY:
" , .
10 ~ ,.
..
lA/Ire IS
.AI,. '{!'
STATE: -flYlA ~
/
jV:t6J S ~;::; .0,
. CONST.
CONTRACTOR'S NAME ,/1 ADDRESS..,,'. ... CONTRACTOR /I. EXL'lES PHONE
GENERAL' (A/ / R_1:5 (; TtJ S- .k-"{J ( .3.2 ~ V'7 W/\otf '1 t/7 77tJt/
PLUM'BING, S - -J - 4tao\b\ I h"?: ~ /n,u;' ~, 'J--L,f 7 </7 $? Y1
MECHANICAL: tv IrtT ~ <:) \~/o..4--. ." ,
e, Ib <~/ 7tJ a-~::r:-II ~\35\ Z l-J '
-. - fl~fV~-r1--~
- OFFICE ~SE ""-
LAND USE: l_\\ " \ '. I
/I OF UNITS: V
CONSTR. TYPE: V I -
HEAT SOURCE: \0\--\
p/
----.
DESCRIBE WORK:
NEW ~ REMODEL
/'
ELECTRICAL:
QUAD AREA:
~P~0
J
,(?-~*W\
~.
7../
/I OF BLDGS:
OCCY GROUP:
/I OF STORIES:
WATER HEATER'
ADDITION
DEMOLISH
JOB NUMBE~ ' q \ 031 (0
225 Fifth Stre,et:
Springfield, Oregon 97477
\'. t, -^ ~ <:.
TAX LOT:
DAY' I_~
tJ!Pn-~-J/5
%.
r
RANGE:
SUBDIVISION:
PHON 1='
ZIP:
OTHER
\d'la./3S-3.
FLOOD PLAIN:
ZONING CODE: _'- ~D ~
~
/I OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAG E: ---L.11l-t2-
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.
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
D Masonry - Steel location, bond
beams, grouting.
~ Foundation - After forms are
~erected but prior to concrete
placement.
o Underground'Plumbing - Prior
to filling trench.
K7f' Underfloora-lumbinQ)Mechanical
~ - Prior to lnsulatlon or decking.
~Post and Beam - Prior to fioor
,~insulation or decking.
. I
M Floor Insulation - Prior to
~ decki ng.
lXf Sanitary Sewer - Prior to filling
I ... trench.
r\:;rStorm Sewer - Prior to filling
~ trench.
I
I
M"Water Line - Prior to filling
~ trench.
rU Rough Plumbing - Prior to
~ cover.
REQUIRED INSPECTIONS
I\.A'Rough Mechanic'al -" Prior to
~ cover.
. .
br Rough Electrical ~ Pri~r to
~ cover.
- -#
1.><' I Electrical Service - Must be
~ approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
g Framing - Prior to cover.
~Wall/Ceiling Insulation - Prior to
~over.
~DrYWall - Prior to taping.
o Wood Stove - After installation.
o Insert - After fireplace approval
and installation of unit.
~ Curbcut & Approach..... .After
~ forms are erected but prior to
placement of concre.t~. ..
.,
fY'1 Sidewalk & Driveway - After
~ excavation is complete, forms
and sub-base material in place.
.'
D Fence- When cO~Pleted.
.. .
~~eet T..es - When ~" ~eqUi'ed
t es are planted.
~FinaJ Plumbing - When all
~ plumbing w()rk is complete.
r')((Final Electrical - When all
~ electrical work is complete.
191' Final Mechanical - When all
~mechanical work is complete.
1S<r Final Building - When all
. ~requjred 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.
~
r
o Final - After all required '
, inspections are approved and
porches, ski rti ng, decks, and
venting have been installed.
#
Lot faces -IV- Lot Ty Setbacks IS THE PROPOSED WORK IN THE
$j.:)J I P.L, HSE I GAR~ Ace! HISTORICAL DISTRICT, OR ~O
Lot sq. ftg. Interior IN 12.0 - THE HISTORICAL REGISTER? _
Lot coverage ~ L Corner If yes, this application mus e signed
~ Is 38'1 and approved by the Historical
Topography Panhandle Iw ~ Coordinator prior to permit issuance.
Total height Lc) .I Cul-de.sac
IE I~~' I APPROVED:
BUilDING PERMIT
~S4
4lo~
ITEM
X $/SQ. FT.
~q .']()
/ {.4 .\D
VALUE
4qn~
JL15/4
Main
Garage
Carport
Total Value
,r:{p :2..q 1
3o'.f ~o
Js..~o
~'Y.2D
Bui/ding Permit Fee
State Su rcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) $1U(,
PLUMBING PERMIT
ITEM FEE
Fixtures
Residential Bath(s) NO 2- ~.(}Q
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
Mobile Home
Plumbing Permit
State Surcharge ~00I>
Total Charge (C) / ~1!J.tSIIJ
MECHANICAL PERMIT'
Fumace
Exhaust Hood
I
NO :2..
AID
LO.cP
Vent Fan
Wood Stove/Insert/Fireplace Unit
3.CXJ
,~ /)0
D-cP
l .
I.~~
c9L()~Q5
Dryer Vent
I
Mechanical Permit
~
Issuance
State Surctlarge
Total Per,nit
(D)
MISCEllANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk ~2- ft
Curbcut. 2'- ft
-J!t ! eJ
/3 ~ 9"
Demolition
State Surcharge
plk:J cK. rC~
~fO
lL3.a.D
14 '11.1 ,
Tota.l Miscellaneous Permits (E)
I
l.
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
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.
.-, ~ J'n ~-!:! .,~~t1O..
Plan Check Fee: .... nK \:- ~
Date Paid:
Receipt Number:
Re7~~~
Plans~~wed By
~#"/2L
" . D~e
Systems Development Charge is due on all undevE'loped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
~- ~
(~_..' ~,
fD'u \ FO'\S~
By signature, I state and agree, that I have carefully exa.llined
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
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 the Site75!:t all times, ring construction.
Signature
Date ~ J.f /9 I
//
VALIDATION:
RECEIPT NUMBER t q 8 3q
DATE PAID ~ 'L2>.Q( >
AMOUNT RECE~! , ItS (d, .OCj
RECEIVED BY <-A {))Q , '