HomeMy WebLinkAboutPermit Miscellaneous 1998-9-14
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Oil ice: 726.3759
LOCATION OF PROPOSED WORK'
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ASSESSORS MAP'
LOT'
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SPRINGFIELD
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BLOCK:
OWNER: ~1/
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CITY' SoOt?
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DESCRIBE WORK: JIM"'~
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JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
TAX LOT:
SUBDIVISION'
o I I !9-rJ
PHONE:
74. t - 79d.d..
.__ ZIP'
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ADDITION DEMOLISH OTHER
IJt.N" Illl~e~""
NEW REMODEL
CONTRACTOR'S NAME
GENERAl'
PLUMBING:
MECHANICAL'
:-l f') ~
ELECTRICA' .
ADDRESS
CON ST.
CONTRACTOR'
EXPIRES .", PHONE
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- OffiCE USE - . ou to
ATTENTION:Oregon law reqUIres Y .,
QUAD AREA- LAND USEfollew nJl~. ....n~t"rl bv !he OreAA.lb'6t,i!IWLAIN'
IIlnTI"r:. . . ' C t Those rules are set'1orm
. O~B~OOS: . OF UNItlP.tlhcatlOn en er. .' h OAIlWWOO1€JDE: _
'n OAR 952-UU1-UUIU ulluug
oP&c;8~B~pT SHALL EXPIRE IF T!:jE WOR~oNSTR. ~15!je: >{:I.' ~.\' nht"in copies of tb~I~BRlt,s'
.~Y:T!mm~ UNDER THIS PERMIT IS NOTHEAT souR@lIingthecenter. (Note: t~e ~~~RY HEAT:
COMMENCED OR IS ABANDONED FOR number for tne. ureyulI Utility
WATER HEATER: RANGE: _ ~oro" 1.ROO-332-234~bUARE FOOTAGE:
ANY '1811 nA Y PFRfnn
To request an Inspection, you must call 726-3769. Tt,ls Is a 24 hour recording. AlllnspectJons 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.
D Temporary Electric
D Site Inspection - To be mado
after excavation, but prior to
selling forms.
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
D Masonry - Steel location, bond
beams, groutIng.
D Foundation - 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 Beam - Prior to floor
Insulation or deckIng.
D Floor Insulation .:...- Prior to
decKing.
D Sanitary Sewor - Prior to filling
trench,
D Storm Sewer - Prior to filling
trench.
D Water Line ~ Prior to filling
trench.
D Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
D Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtai n permanent
electrical power.
D Fireplace - Prior to facIng
materials and framing Insp.
D Framing - Prior to cover.
D Wall/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
D Wood Stovo - After Installation.
D Insert - After fireplace approvel
and Installation of unit.
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sidewalk & Driveway - After
excavation Is complete. forms
and sub.base material In place.
D Fence - When cOi....'lpleted.
D Street Trees - When all required
trees are planted.
D Final Plumbing - When all
plumbing wQrk Is complet,e.
D Final Electrical - When all
electrical work Is complete.
~inal Mechanical - When all
mechanical work Is complete.
D Final Building - When all
required Inspections have been
approved and building is
7mPleted.
5Zf Other ~ -t-eS r-
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
Inspectlons are approved and
porches, skirting, decks, and
venting have been Installed.
I
Lot faces
Lot SQ. flg.
loot coverage
Topography
Total height
BUILDING PERMIT ",
ITEM
SQ. FT.
Main
Garage
Carport
Total Val ue
Building Permit Fee
Slate Surcharge
TOlal Fee
L~t ~y.
Interior
Corner
Panhandle 't.
Cul.de-sac
"
"
.~
. . :.' f"l ~;,;:~.;1
.
. IS THE PROPOSED WORK IN THE.
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be slgnod
and approved by the Historical
Coordinator prior to permit issuance.
X $/50. FT.
(A)
Setbacks
I P.L. HSE GAR ACC
.tL- __..
S
~-,-
VALUE
"
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Resldenllal Balh(s)
N'
Sanitary S~wer
Water
FT.
Storm Sewer
FT,
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/Insert/Fireplace Unit
Dryer Vent
(P0.h- rrp; (1-'-
Mechanical Permit
Issuance
State Surcharge
Total Permit
(C)
(0)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
fl
Curbcut
fl
Demollllon
State Surcharge
Tolal Miscellaneous Permlls (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
tpl<':;,-
tin . -
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APPROVED:
. ":". ., "
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'
Dale Paid:
Receipt Number'
Received By:
Plans Reviewed By
Date
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
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 pertaining to the work described
herein, and Ihat 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 to ensure that all required Inspections are
requested at the proper time, that each address Is readable
Jrom tile 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 mes dur~ construction.
Slgnalur~ t'A.... '::1... ---
Date ( i' _I i/Ae
VALIDATION:
RECEIPT NUMBER .31 <10;)-
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AMOUNT RECEIVED .:t o'W
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DATE PAID
RECEIVED BY