HomeMy WebLinkAboutPermit Building 1999-6-11
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
ASSESSORS MAP'
LOT'
CITY'
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. SPRINGFIELD
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rfd770
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
...............,
BLOCK'
TAX LOT'
SUBDIVISION:
116 U ()
PHONE: _--:;:YJa-O 9/~
Of - ZI~: 97-Clt-!::f-
(l f111F1 fL.
STATE: .
DESCRIBE WORK: . ~{l.(. f ;)/-r-J..!-
NEW REMODEL ~ ADDITION
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-,...., ".-..r-I' =SHAIl.I!lW1!r;lB llAlWEHtlOOK
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WATER HEATER' RANGE: :.:J11-'~R"Z=I1UNDER;1:l-dIA~il~OT
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To request an Inspection, you must call 726-3769. This Is a 24 hour recordl,^Q..~J.Jy:~tr.s requested before 7:00 a.m. will be
made the same working day, Inspections requested aller 7:00 a.m. MH'lb6t)1i!ttfe tfi.fWh'owing work day.
D Curbcu\ &, AI,proach - Aller
forms are emcted but prior to
~..~~~.ltaly S~~er .-;-I~rio"rto f1!lIng ...." ~tp~aceTOr?t of concrete.
LT-J trench: '. '. !. ;0.JJ,.I, ,._~J/'T:.J/ .).).
... . . - D Sidewalk & Driveway - Aller
D Storm Sewer -- Prior to fllllrig excavation Is complete, forms
trench. I' f' I ': and'sub.base material In place.
. , , ' . ,~",
(", ',.,.....1 "I .
..,. I \. ;~
D Waler Line - P;'iO..,t~ f.llllng, . \
trench. _ J i I \ ).!
,--.... '--J '- ~~ ~. t.
. '. ~ . .,
D Rough' Plumblo'i f PrlP.f t? ~. _.r'~
cover. l\ . 1(\
I,.... ,,,.... '-..'.... \ '-
CONTRACTOR'S NAME
r-x UrJK-P_
GENERAL:
PLUMBING'
MECHANICAl'
ELECTRICAl'
QUAD AREi"
. OF BLOGS:
OCCY GRO\lP'
. OF STORIES:
D Temporary Electric
D Site Inspoctlon - To be made
after excavation, but prior to
settIng forms.
D Underslab Plumblng/Eleclrlcall
(6)eChan'ca' - Prior to cover,
Footing - After trenches are
excavated,
D Masonry - Steel location, bond
beams, grouting.
o Foundation - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench. r
,.
D Underfloor Pluml>lng/Mechanlcal
- Prior to Insul~tlon or decking.
D Post and Boam - Prior to floor
Insulation or decking.
....
D Floor Insulation - Prior to
decking.
.
,-
DEMOLISH
, OTHER
ADDRESS
CONST.
CO!,!TRACTOR .
"
PHONE
EXPIRES
. . - _'_'!'''gq"irQc::.ynllto
All tl'llIVl'4.VIC;;~....".J :'. . .
I-u^", ...I,,~ "rlnoted bv the Oregon Utility.
N~tiiication Cent~~}:~o~:. r~le;:~~ea~tl;~~;'~
in OAH ~o~.uu ,-vv I'" ...1.. ......at: -
:}::CC v"" m"" ohtain cODies 01 the rules by
_ .",_'- ....~ "..n'''' (Note: the lelepnu"..
n~~b8r 10;.l!',oiO;rc-EPO~ililV NotlllCaUUl1
Center is 1.800.332-2344).
LAND USE: .
FLOOD PLAIN:
. OF UNIT~:
ZONING CODE: _
'. CONSTR. TYPE:
. OF BDRMS:
HEAT SOURCE:
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
D Final Plumbing - Whon all
plumbing worl< Is complete.
. .
D Rough Electrical - Prior to
cover.
D Final Electrical - When all
electrIcal work Is complete.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Final Mechanical - When all
mechanical work Is complete.
@'>
Final BuildIng - When all
D required Inspections have been
approved and building Is
completed.
D Fireplace - Prior \0 facing
materials and framing Insp.
@ra;"lng - Prior to cover.
D Wall/Ceiling Insulation - Prior to
cover.
DOlher
D Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
D Wood Slovo - After I~stallatlon.
..:.
D Insert - After fireplace approval
and Installation of unit.
D Blocking and ~e\.Up - When all
blocking Is complete.
D Plumbing Connoctlons - 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 Fence - When corilpleted.
D FInal - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
('
D Street Trees - When all r~qulred
trees are planted. .
f
Lot faces
~t ~yp.
Interior
lot sq. Itg.
lot coverage
Corner
Panhandle 'yo:
Topography
Total height
Cul.de-sac
BUILDING PERMIT :"'.;1 't
ITEM
sa. FT.
X s/sa. FT.
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
~J' ~
!.,",\
. k!, ":L'.' :.:'F1;.~h~":;!'~~~"
. .';1: ':J
I P.l.
N
s
W
-----
E
VALUE.
"
7;.oo"!J-
/
. ~f;57J
)PY 3,t{3
7377
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary S~wer
Water
FT.
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(0)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
SIdewalk
It
Curbcut
It
Demolition
State Surcharga
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
FEE
LJ.L ,- 2...
Setbacks.
HSE GAR
. . ~
'.S THEPROPO~EO WORK iN THE.
HISTORICAL oIIlTRICT. OR ON
THE HISTORiCAL REGISTER?
II yes. this application must be signed
"lid approved by the Historical
Coordinator prl~r to permit Issuance.
ACe' I
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I
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APPROVEO'
.. .~ '.'1 "
BUILDING VALliE, 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,
Plan Check Fee:
tLl(. S ]
Date Paid:
Receipt Number'
"
Received By:
Plans Revlewod By
Dale
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
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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 perlalnlng 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 ORS 701.055 will be used on this
project.
ree to ens~re that all required Inspections are
request at the propttr time, at eas!l.addres"s"ls.re able
from th teet. that the por d Is 10caWp at the fro t
of the p 0 rty. and he a ~. ~l:. Will remaIn
on the s r ns on.
.,
~atu,,: .
;'1,. . , -
Dat~
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~:~:I::~:MBER ~~
DATE PAID { 0 . I ( . '-1,
AMOUNT RECEIV~ol \\~ .~b
RECEIVED BY ('7\~