HomeMy WebLinkAboutPermit Building 5-8-11 (2)
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
SPRINGFIELD
LOCATION OF PROPOSED WORK: ~ hi
ASSESSORS MAP: /7~_~ -~-::z/
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:-~--: ./~C&- /'
LOT:
BLOCK:
JOB NUMBER 9~~7'9':3
225 Fifth Street
Springfield, Oregon 97477
TAXLOT:~~~~
SUBDIVISION'
OWNER:M~Fu:?/E Pf'l~4AL~&F.?"?e~~P//.#.&:. PHONE: ?~-~o/"5:::>
ADDRESS: /~~ 6 ~.
CITY:
~~~.
- - /
STATE:
~..
,.
ZIP:
~7V./?
DESCRIBE WORK:~~?:,~'ve=7I~.~~cA ,~~;? ~~ ~/
NEW Y REMODEL ADDITION DEMOLISH OTHER
CONST.
CONTRACTOR'S NAME ~.cB.~/~X?' CONTRACTOR /I EXPIRES .:. PHONE
GENERAL:~M'/A/~:"~ ~~~-N'~':~~.q_ ~_-:;J~ ~ /7i:~~_ dS$3"~?
PLUMBING:
MECHANICAL:
ELECTRICAL:
QUAD AREA: -2~#'W'
'" /'
OCCY GROUP: .75--3
I
/I OF BLDGS:
/I OF STORIES:
WATER HEATER:
- OFFICE USE -
LAND USE:
////
I
FLOOD PLAIN:
ZONING CODE: L.rj1q
/I OF BDRMS: ~
SECONDARY HEAT:
SQUARE FOOTAGE: '??$"'2..
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.
o Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumbing I Electricall
Mechanical - Prior to cover.
[t[J Footing - After trenches are
excavated.
D Masonry - Steel location, bond
beams, grouting.
[!] Foundation - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
m
Underlloor Plumbing I Mechanical
- Prior to Insulation or decking.
[l] Post and Be'am - Prior to floor
Insulation or decking.
[2] Floor Insula'tion - Prior to
decking.
rn Sanitary Sewer - Prior to filling;
trench. ~
[2] Storm Sewer - Prior to filling
trench.
[Aj W~ter Line - Prior to filling
trench.
r7i1l Rough Plumbing - Prior ~o
~ cover. ..
/I OF UNITS:
CONSTR. TYPE:. ~ :s~/-{' .
",
HEAT SOURCE: ~~J::.r ~J ~
RANGE:
REQUIRED INSPECTIONS
[A] Rough Mechanical - Prior to
cover.
r7l Rough Electrical - Prior to
LflU cover.
r:i7l Electrical Service - Must be
~ approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
[i(J Framing - Prior to cover.
~ Wall/Ceiling Insulation - Prior to
cover. '.
~ Drywall - Prior to t.aPlng.
D Wood Stovo - After Installation.
D Insert, After fireplace approv!ll
and Installation of unit.
~ Curbcut & Approach - After
forms are t)rected 'but prior to
placement of concrete. .
~ Sidewalk & Driveway - After
l.LlJ excavation Is complete, forms
and sub.base material In place.
~ Fence - When completed.
rvI Street Trees - When all required
~ trees are planted. .,
[2] Final Plumbing - When all
plumbing W9rl{ Is complete.
rn Final Electrical - When all
electrical work is complete.
[l] Final, Mechanical - When all
mechanical work is complete.
r-:vl Final' Building - When all
L,.4.J required Inspections have been
approved and building is
completed.
Cll Oth~r J(~,,? r P
~~~~~~
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.
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
venting have been Installed.
.~' . .
Lot Ty~
Interior I P.L.
~ Corner IN
Is
Panhandle
Iw
Cul-de-sac
IE
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
BUILDING PERMIT
?7~~.......P'
, ''-
", .,9.~~
-41'~ . ~
~~.zg
I~. 'Y'f
SYSTEMS DEVELOPMENT CHARGE (SDC)
~o/JI. ~
ITEM
sa. FT.
X $/SO. FT.
Mai n ?39Y2
Garage
Carport
~Q/ ~~
~t;I
-
Total Value
Building Permit Fee
State Surcharge
Total Fee
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) NO
Sanitary Sewer FT.
Water FT.
~
Storm Sewer FT.
-92
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace -;:J
Exhaust Hood ""::?
Vent Fan
NO
5"
Wood Stove/lnsert/Flreplace Unit
Dryer Vent "" A~ ~ .
-g' ~ ~d./~
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk ~r'~ ft
Curbcut 9LJ ft
.c.- --: "~/",~6I'c F( ~/.:?6a )
$~='~~~)
Total Miscellaneous Permits (E)
" TOTAL AMOUNT DUE (excluding elecirical)
(A, B, C, D, and E Combined)
VALUE
~c;-.&-~ t~'
-r
"
(A)
(B)
FEE
/92.~
~~. ~ t:>
~
... "'" ~ -< -,~
-//.€3
. ~.~
-:::z. 57 . / /
--.L$. .-c:o
"'7, _0
/?~
6.,e>
~.--
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/~ 6-b
~~ '1~
21. ~S
.//.~
~~$&'
.r::;-:~
2$1'2- ~
~~,2~
/ "'" "3~_ ~r'
;, 'i\ ~ ,.'1:" ~\'
,}",
Setbacks
HSE GAR ACC'
\ IS THE PROPOSED WORK IN THE,
. HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
. APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This p~rmit 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: ~.4!J} ~$7.
Date Paid:
Receipt Number:
Received By: __."
~~.
S/-- ::>-~.5'
Date
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS (r-.~S)
~o.??#~/ ~~-<2>L~~/LL
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(S'?d/1"#-) (~~~~) (~:...J-:-
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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 Ordinances0'f 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.
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 .remaln
on<the site ~t ~ limes \dU',' ng c\l1stru,tion.
~:atu,"="_~ ~
~ ~. -
VALIDATION: rh
RECEIPT NUMB?r" R \t.r...\o~
DATE PAID t') ./1 q~
AMOUNT RE(;f~D -.B2~?. ~
RECEIVED B~~