HomeMy WebLinkAboutPermit Building 1992-4-7
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Ollice: 726.3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP'
LOT:
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ADDRESS: (D 'L lJ IS: I!.lt.'::'
CITY: ~P"-I.J74t='\I!.^-r>
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SPRINGFIELD
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DESCRIBEWORK:~/lowP", *" ,.,>fL..-I1..-2..,?1
NEW
REMODEL
ADDITION
DEMOLISH
OTHER
!B NUMBERq ")fY-Y1.-l
225 Filth Street
Springfield, Oregon 97477
TAX LOT: c:f7.AOO
SUBDIVISION'
PHON~./4-'1.~";'f,~
ZIA.., 4,"1""
CONST.
CONTnACrOrl'S NAME ADDRESS CONTRACTOR" I:.XPIRES
C EN mA L:~""'S. .Gi'....~__3=\U>\ 1?_l0.a:lQl-l ~_/M"'\UDl...J\-__'5'5 \5~. . - ~/:J-t;/3 2,
PLUMflING:
MI:.CHANICAL'
ELECTRICA' .
PHONI:.
.~~_- :Z"'~'b
- OFFICE USE -
OUAD AREA' LAND USE: FLOOD PLAIN:
. OF BLDGS: . OF UNITS' ZONING CODE:
OCCY GROUP' CONSTR. TYPE: . OF BDRMS:
. OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGE: SQUARE FOOTAGE:
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
milde the same working day. Inspections requested after 7:00 a.m. will be made the (ollowing work day.
D Temporary Electric
,- I Sito Inspection - To be made
after excavation, but prior to
setting forms.
D
Underslab Plumbing/Electricall
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
Underfloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Post and Beam - Prior to tloor
insulation ~r decking.
D Floor Insulation - Prior to
decking.
D
Sanitary Sewer - Prior to filling
trench.
D Slorm Sewer - Prior to filling
trench.
D Waler Line - Prior to filling
trench.
D
Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
'r\t1 Rough Mechanical - Prior to
r cover.
r\7l Rough Electrical - Prior \0
~ cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framl~g Insp.
P Framing - Prior to cover.
D Wall/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
D Wood Stove - After Installation_
D Insert - After r1replacc approval
and Installation at 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 completed.
D
Street Trees - When all required
trees are planted.
~Final Plumbing - When all
r plumbing work is complete.
~ Final Electrical - WI-len all
~ electrical work is complete.
~ Final Mechanical - When all
r mechanical work is complete.
~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 - 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 10
the service panel.
D Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.
Lot Type. Setbacks
Interior I :.L HSE GAR ACC
Corner
Is
Panhandle
Iw
Cul.de.sac
IE
Lot faGes
Lot sq. ftg.
Lot coverage
Topography
Total height
BUILDING PERMIT
ITEM
sa. FT.
X $/sa. FT.
VALUE
Main
Garage
Carport
Total Value
::WOO .6D
~.SD
~_ .J.:.lo ?
~~_~3 .13
Building Permit Fcc
Stale Surcharge
Total Fcc
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
?y-"r.'1J,
Fixtures
---" "-,
Residenlial Bath(s)
N'
Sanitary Sewer
FT.
Water
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
'bo.C5D
I.Sc0
:,\.~O
State Surcharge
Total Charge
(e)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
:',00
Wood Slovcllnsert/Fircplacc Unit
Dryer Vent
Mechanical Permit M\ '" ~
15.61>
\ II . (51)
1,:25
1. (p. 7..~
Issuance
Stale Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
Stalo Surchorgo
Sidewalk
ft
Curbeul
ft
Demolition
Stille Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
CJ I. 3Z
eS THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, Ihis application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED'
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.
Plan Check Fce:
Date Paid:
Receipt Number
Receivecl By:
Plans Reviewed By
Date
Systems Developmcnt Chargc is due on elll undeveloped
properties within OlC Cily 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 truc 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 pert(lining 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 CAS 701.055 will be used on this
project.
c
I further agree to ensure that all required inspcclions arc
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.
Signaturn J ~ 1/k
Date Nl-f-.2;/ '" rz-
VALIDATION:
RECEIPT NUMBEJ~ Do4'"l.4~
DATE PAID 0 4f''/ "1'2.
AMOUNT RECElv-!(n Cj I.'~ .
RECEIVI:.DBY \.. \~ ~
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