HomeMy WebLinkAboutPermit Mechanical 7-10-17
RESIDENTIAL
. PERMIT APPLICATION
Inspections: 726:3769
Office: 726.3759
SPRINGFIELD
LOCATION OF PROPOSED WORK: 59%9 jj -dU,JJ#T:
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ASSESSORS MAP:
LOT:
ELECTRICAl'
QUAD AREA:
# OF BLDGS'
OCCY GROUP'
# OF STORIES:
o Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
D Footing - After trenches are
. excavated.
D Masonry - 'Steel location, bond
. beams, grouting.
o 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.
o Floor Insulation - Prior to
decking.
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench. :
o Water Line - Prior to filling
trench., ,
o Rough Plumbing - Prior to
cover.
JOB NUMBER
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225 Fifth Street
Springfield, Oregon 97477
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TAX LOT:
97(/7,5
hl-4'2. '},
V'-"':'
,
BLOCK:
STATF'
(),.€
OWNER: .~fl/ul(),' )~//J~A~ )
ADDRESS: ~ 9j'fj ~ /iif.u_t,
CITY: 4tJJn~rJ~.J,t1f)ci
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DESCRIBEWORK:~U;-j;j4~4) -JuuIIQLL~~ Q \.t1le-_l\o~te(L.J
NEW X REMODEL ' ADDITION ,',' DEMOLISH OTHER '
SUBDIVISION:
PHONE: 747-5~C/7
ZIP:
9'7~7J1
ADDRESS
CONST.
CONTRACTOR ,#
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D Fireplace - Prior to facing
materials and framing Insp.
D Framing - Prior to cover.
D Wail/Ceiling Insulation - Prior to
cover.
D Drywall- prl,or to tapln~.
o Wood Stove - After Installation.
o Insert - After fireplace approvl:ll
and installation of unit.
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sidewalk & Driveway - After
excavation Is compiete, forms
and 'sub.base' material in place.
D Fence - When cOi'tlpleted.
D,Street Trees - When all required
, trees are planted. '.
EXPIRES
PHONE
-~FFICE USE .,-
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I LAND U?~~~
1t-:>'.-:,<).... ~
# OO~~~ "~;
~ '~4 ~~
HEA~U%: -% ~/ ~
. "? J.. O~ ~ '-1;0
WATER HEATER: RANGE: '~, {f ~ ~t SQUARE FOOTAGE:
. . ~,._", ~. X>(,/) 4~:& V,(\~~ /,(:.)~ .
To request an Inspection, you must call 726-3769. This Is a 24'nour ~dl'~...A pectlons requested before 7:00 a.m. will be
made the same working day, Inspections requested after 7:0~ a.m..;;jf?~~~ t ~ollowlng work day.
REQUIRED INSPECTI~S1'o,>- rt-
~U9h ~a~cal - Prior to 0 Final Plumbing - When all
cover. _~~ " plumbing W9rl< Is complete.
D Rough Electrical -:' Prior to D Final Electrical ,-- When all
cover. .., electr~I' al ork Is complete.
DEI . I S I'M ~nal - When aI/
ectnca erv ce - ust be L1::1 ~~chanlca ork Is complete.
approved to obtain permanent
electrical power. '
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FLOOD PLAIN:
ZONING CODE:
# OF BDRMS:
SECONDARY HEAT:
D Final Building - When all
required Inspections have been
approved and building is
completed.
D Other
MOBILE HOME INSPECTIONS
o 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 faces Lot Type
Lot sq. ftg. Interior p.L.
Lot coverage Corner N
Topography ~' S
Panhandle '
Total height Cul-de.sac W
E
'\'.,.' ':':,' :, \, ,.,,' I ~"
,; ~1:..~i~jf.L: ~ " .
Setbacks '
'HSE'GAR'ACdl
BUILDING PERMIT ':'i
t
ITEM
SQ. FT.
X $/ SQ. FT.
VALUE
Main
Garage
"
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s) NO
Sanitary S~wer
Water
FT.
Storm Sewer
FT.
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Mechanical Permit
\~PO
lO,~
. l.W
R.\o ,~
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
&~ .~Q
1<:> THE PROPOSED WORK ~N 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.
I
I
BUILDING "ALOE, PLAN CHECK
AND BUILDING PERMIT
APPROVED:
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:
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 aI/
Information hereon Is true and correct, and I further certify
that any and all work performed shal/ 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 that NO OCCUPANCY wil/ 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 remain
on the site at aI/ times during construction.
~ature Y)tZ11.&J {I, J/J;Au
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Date /iJ -/7-1/7
VALIDATION: Il(l rv1 to
RECEIPT NUMBER~()r r no,_
DATE PAID , _ V \0 .\.l,q 1
AMOUNT REC~ll~D ' &J
RECEIVED BY cNM ,