HomeMy WebLinkAboutPermit Plumbing 8-3-16
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
.-.
LOCATION OF PROPOSED WORK: Zf0-1 h'},Sev- I L4P1.L
ASSESSORS MAP: l~ OA" 0 lt7 / If
LOT:
BLOCK:
OWNER:_y.,/r_0Q~/ c.ur>...... . ,,-}-.I"
ADDRESS: 1ft} ;::/n,,,-.;. La...~
CITY: 5 /l./I~7) 1,'.,..1
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DESCRIBE WORK:
NEW '/.- . REMODEL
CONTRACTOR'S NAME,
GENERAL' P/~ h!"')
PLUMBING'
MEC~ANICAL:
ELECTRICAL:
tv.......u\
QUAD AREA:
# OF BLDGS:
OCCY GROUP:
# OF STORIES:
WATER HEATER:
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STATE: ~() It..
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ADDITION
DEMOLISH
OTHER
....
JOB NUMBER
<1 ~ 3/<.{
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225 Fi fth Street
Springfield, Oregon 97477
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TAX LOT: ()) &'1C'}
SUBDIVISION'
PHONE: ) w.,,- 79w
ZIP:
CONST.
CONTRACTOR #
ADDRESS
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LAND USE:'~ ~ .":.~ ~'\.
1},... "1"", ~n ~
# OF UNITS: VA ~. v.^ ~"
-; .,~ - ~ )-
~q~ ~;..~~
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t~ -to,>- 7if'
CONSTR. TYPE:
HEAT SOURCE:
RANGE: __
EXPIRES
PHONE
.,:;:'l
Ljf'l/-'9r? 9
FLOOD PLAIN:
ZONING CODE:
# OF BDRMS:
SECONDARY HEAT:
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
made the same working day, Inspections requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
o Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
o Footing - After trenches are
excavated. .
o Masonry - Steel location, bond
beams, grouting. '
o Foundation - After forms are
erected but prior to 'concrete
placement. '
D Underground Plumbing - Prior
to filling trench. .
o Underfloor P,lumbing/ Mechanical
- Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
o Floor Insulation - Prior to
decking.
I
o Sanitary Sewer - Prior to filling
trench.
o Storr Sewer - Prlor'to mling
tre .
,
ater Line --: Prior to filling
trench.
~
D Rough Plumbing - Prior to
cover.
D Rough Mechanical - Prior to
cove~ '
D RoughEleclrical ....,. Prior 10
cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
o Framing - Prior to cover.
o Wail/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
o Wood Stove - After Installation. .
o Insert - After fireplace approvlll
and Installation of unit.
O 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.
o Fence, - When cOi"rlpleted.
D Street Trees - When all required
trees are.planted.
~i Plumbing - When all
'. plumbing ,w<;>rl< Is complete.
D Final Electrical - When all
electrical work is complete.
o Final Mechanical - When all
mechanical work Is complete.
o Final Building - When all
required Inspections have been
approved and building is
completed.
D Other
MOBILE HOME INSPECTIONS
D Blocking and Set-Up - When all
, blocking Is complete.
o Plumbing Connections - When
home has been connected to
water and sewer.
o Flectrical Connection - When
blocking, set-up, and plumbing
Inspections have been approved
and the home Is connected to
the service panel. .
o Final - After all required
" Inspections are approved and
porches, skirting, decks, and
venting have been Installed.'
.'f
"" 1; ;: .; ~~;~i::'JlS~';
~~
Lot faces
Lot TYf!r
Interior
P.L
Setbacks .
HSE GAR I ACe' I
.1
.1
IS THE.PROPOSED WORK iN THE _
HIST081CAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
Lot sq. ftg.
Topography
Total height
~'
Panhandle '
N
Is
Lot coverage
Corner
Cul-de'sac
W
\
E
APPROVED:
BUILDING PERn1JIT 'fi
ITEM sa. FT.
. f!
'it
X $/SO. FT.
VALUE
..,., "',.. .' '},
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Garage
"
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.
Main
Carport
Plan Check Fee:
Date Paid:
Tolal Value
.-
Receipt Number'
Building Permit Fee
Received By:
Stale Surcharge
Total Fee
(A)
- <' :~:~t
Plans Reviewed By
Date
Sanitary S~wer
. ,'t:, ,.'
SYSTEMS DEVELOPMENT CHARGE (SDC).....( t' ..~ystems Development Charge Is due on all undeveloped
:,,"};" .,:(,~'6roperties within the City limits which are being improved.
(8) ~...~..~~. ,.. -.)'0 }.,:i~;."" A.XI.
. .'....t "~ 1 ,"~ ..~. - ....\.. ....
<~'\ ~(.\. -~,,'A[).oITIONAL COMMENTS
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F~E .~\,~-~-.." '....' i' ~(:..
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c.~,,, (~~,. ..1".> ~^'.
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PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
FT.
Water
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
+ 0,03 M~
(C)
1/-f-0.-
~r-+- 1.;).0
f 1{3. d-O
Total Charge
MECHANICAL PERMIT
Furnace
Vent Fan
NO
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 ali work performed shall be done in accordance
with the Ordinanc~s 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 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/Insert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
\
State Issuance'
'-
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 times during construction.
i4'L~
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Surcharge
Sidewalk
ft
~Ig'nature
(}ate Z - I L. -11,,1
Curbcut
ft
Demolition
State Surcharge
VALIDATION:
"
Total Miscellaneous Permits (E)
8...1/67
DATE PAID '3 - I Co - CJ \(
AMOUNT RECEIVED .it 4-~,. ?--6
RECEIVED BY ~
RECEIPT NUMBER
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
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