HomeMy WebLinkAboutPermit Backflow Test 1993-11-10
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
'LOCATION OF PROPOSED WORK:
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LOT:
SPRINGFIELD "
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BLOCK'
OWNER'
ADDRESS'
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CITY'
STATE:
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DESCRIBE WORK:
NEW ~EMODEL
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ADDITION
DEMOLISH
OTHER
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JOB NUMBER
9Jc24L
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225 Fifth Street ,
Springfield, Oregon 97477
TAX LOT:
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SUBDIVISION'
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PHONF'
ZIP:
9 '7404
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CON ST.
CONTRACTOR'
CONTRACTOR'S NAME ADDRESS
GENERA" MCY~ /,Al;'J~r
PLUMBING: ,f?eA-A JL. (" ;fP-?L/V~
MECHANICAL'
ELECTRICA' .
EXPIRES
PHONE
- OFFICE USE -
QUAD AREA: LAND USF' 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. Atl inspections requested before 7:00 a,m. will be
made the same working day, Inspections requested after 7:00 a.m. will be m~de the following work day.
o Temporary Electric
o
Site Inspection - To be made
after excavation, but prior to
setting forms.
o
Underslab Plumbingl Electricall
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.
o
Underground Plumbing - Prior
to filling trench.
o
Underfloor Plumbing/Mechanical
_ Prior to Insulation or decking.
o Post and Beam - Prior to floor
Insulation or decking.
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O Floor Insulation - p;ior to" ,'-
decking.
\
O SanitarY Sewer - Prior to filling
trenctl.
o Storm Sewer - Prior to fillIng
trench. .
" "
, '.
o Water Line - prior to, fllilng
trench.
o Rough Plum~ing - Prior to
cover.
~,ro,
o Wall/Ceiling Insulation - Prior to
cover.
REQUIRED INSPECTIONS
o Rough Mechanical - P~ibr to
cover.
. l \
o Rough Electrical - Prior' to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - PrIor to facing
materials and framing Insp.
o Framing - Prior to cover.
D Drywall - Prior to taping.
o Wood Stove - After installation.
D Insert - After fireplace approval
\ \ and Installation of unit.
,
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
o ~ence - When completed.
o Street Trees - V~hen aJlrequired
trees are planted. ,
I><f ~!~~I Plumbing - When all
~mbing work Is complet.e.
\
o Final Electrical - When all
electrical work Is complete.
o Fin..1 Mechanical - When all
mechanical work Is complete.
o Final Building - When all
required Inspections have been
approved and building is
completed.
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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.
o Final - After all required
inspections are approved and
porches, skirting, decks, and
venti n9 have been Installed.
Lot laces
, ,
Lot Type
~
Lot sq, flg.
Interior
Lot coverage
Corner
Topography
Total height
Panhandle
Cul.de.sac
'- '
BUILDING PERMIT
ITEM SQ. FT. X $/SQ. FT.
Main
Garage
Carport
Total Val ue
Building Permit Fee
State Surcharge
Total Fee
(A)
Setbacks
I I I I
HSE GAR ACC
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I
.
I P.L.
IN
Is
W
E
VALUE
-.
-\
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT.
;
Water
FT.
,
FT.
Storm Sewer
Mobile Home
/L,A::i::-fG F~ lJWIc.5
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/Insert/Fireplace Unit
Dryer Vent
'1i
Mechanical Permit
,
.,
Issuance
State Surcharge
,
Total Permit
(D)
MISCELLANEOUS PERMITS
I
Mobile Home
~ !
State Issuance
State Surcharge
Sidewalk
fl
Curbcut
fl'
Demolition
State Surcharge
'.\
Total Miscellaneous Permits (E)
I
TOTAL AMOUNT DUE (excluding clectrlcal)
(A, B, C, 0, and ECombined)
FEE
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IS THE PROPOSED WORK IN THE
"'HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signcd
and approved by the Hlstorica,t
Coordinator prior to permit issuance.
APPROVED'
,
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on tt:le express condition thaI the said
construction shall, in all respects, conform to the Ordinance
adopted by, .the City <<l,Sprlngfield, 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.
I I
" 'Plan Check Fee"'
Date 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 certlly
that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield, and the ~~ws
of the Stale 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.
I further agree to ensure that all required inspections are
requested at the p~oper 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 atJ~1 times during constructIon.
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Date
VALIDATION:
RECEIPT NUMBER
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DATE PAin
AMOUNT RECElv~n
RECEIVED BY
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