HomeMy WebLinkAboutPermit Mechanical 8-2-19
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
17 01
81./
'12- ....
ASSESSORS MAP:
LOT:
BLOCK:
OWNER'
ADDRESS:
CITY:
Dtck ~ /hNt<..; .f4-brollJ
., S- tJ C, 3 a 6- tJl .N;
" tOkj'J/lJh.-hGE lei
-v
STATE: .
O~_-
DESCRIBE WORK:
NEW ,_ /REMODEL
r /IJ .I174l L
h 84- f (/J UvvLlJ
~ '-/ r r:h:Pt
,
ADDITION
DEMOLISH
OTH ER
.~,,-...,""*
JOB NUMBER
q(j, Od ( /.;
225 Fifth Street
Springfield, Oregon 97477
. TAX LOT:
.r.!
SUBDIVISION:
PHONF'
'7 Cf-7-37 3 r:;
ZIP:
4f 7 Y-7!
CONTRACTQR'S NAME
GENERAL:
ADDRESS' .
. CONST. .
CONTRACTOR #
EXPIRES ,~ PHONE
PLUMBING: 4'(.)", ' .. " .
MEC~ANICAL: I*V6l~,*f(~CO,~J~~6g~~ ~~
. / 'YU}j > .<:-~ .:'
'ELECTRICAL: Btc.:.~ ~\....e.~,)V,..," ~.,.~' '~
. . .-v,,~ '~~ I,)"LI
. :~VI- ,w,"{JU <:~3 ;,,:;:1:.[ k
r ,~ . t'~b ~dlFI""~,.dlSE-
i? e:A'~ t9~ ~ ~~ .~~ /,(- ~
. # 0 F ~~~:-1e-1";l)U' ,o~-9Z It~ f.t,,..,
. . UtU ""7JrJ., ~
. CONSTR. TYPE: ~.o ~ ~ AlO
0.-9 r
QUAD AREA'
# OF BLDGS:
OCCY GROUP:
# OF STORIES:
HEAT SOURCE:
WATER HEATER:
RANGE:
77
l'0-3/-11 7,+6.:.fC,:<.l
. 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, .Inspectlons requested after 7:00 a.m: will be made the following work day.'
REQUIRED INSPECTIONS
D Temporary Electric
D Rough Mechanical ~ Prior to
cover. . .
D Site Inspection - To be made
after excavation, but prior to
seHlng forms.
. .
D Rough Eh3ctrical '-,. Prior to
cover. .
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
D Electrical Service - Must be
. approved to obtain permanent
electrical power.
o Footing - After trenches are
'. excavated. .
D Fireplace - Prior to facing
materials and framing Insp.
D Masonry - Steel lC)catlon, bond
. beams, grouting.
o Framing - Prior to cover.
D Foundation - After forms are
erected. but- prior to 'concrete
placement.
D ~;~~~.?~lIIng Insulation - Prior to
D Underground Plumbing - Prior
. to filling trench.
. .
D Drywall - Prl,or to taping.
D Underlloor Plumbing/Mechanical.
-. Prior to Insulation Or decking.
o Wood Stovo - 'After Installation.
D Post and Beam - Prior to floor
Insulation or decking.
D Insert - After fireplace approval
and Installation of unit. .
o Floor Insulation ~ Prior to
decking. .
o 'Curbcut & Approach - After
forms are erected but prior to
placemont of concrete.
o Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior to tilling
trench.
o Sidewalk & Driveway - After
excavation Is 'compiete, forms
and 'sub-base'materlal In place.
o Water Line" Prior to filling
. trench.
D Fence. - "'-/hen completed.
o Rough Plumbing - Prior to
cover.
D.Street Trees - When all required
trees are planted. . .
o Final Plumbing - When all
plumbing w9rl< Is complete.
D Final Electrical ,..... When all
electrical work Is complete.
~I 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
o Blocking and Set.Up - When all
blocking Is complete.
o Plumbing Connections - When
home has been connected to
. water and sewer. .
. 0 Electrical C:::onnectlon - 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.
Setbacks
I P.L. T HSE I GA"Rl Accl
I N I I I I
I S I I I
/W I I
l E -LL.~
., :i.' '", 't.
BUILDING VALUE, PLAN GHECK
AND BUILDING PERMIT
'"
Lot faces
Lot Type
Lot sq. ftg.
InterIor
Lot coverage
Corner
Panhandle ~
Topography
Total heIght
Cul-de-sac
BUILDING PERMIT "j ,';'t
ITEM SO. FT. X $/SO. FT.
VALUE
Main
Garage
Carport
..
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
FEE
Residential Bath(s)
NO
Sanitary S~wer
Water
FT.
FT.
Storm Sewer
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
4fIS,
~IO. __
,7.r:::+ I 4 s:
~ .) L, . d--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)
.' '.; !;" ~i~ :~.:'jr \: ;
IS THE PROPOSED WORK tN 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:
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 0;
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 Deyel9pment Charge is due on all undeveloped
properties Withln,lhe City limits which are being improved.
ADDITIONAL COMMENTS
By signature, I stato and agree, that I have carofully 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 Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertaining to tho 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'roper 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 ad" times;- durl.l39 crrstructl~n.", 4/{n.-.
"~, -O.J~~ Lv,
Signature !~?
;).- 17-7t
Date
VALIDATION:
d- 8 80?
RECEIPT NUMBER. .--/
o . ~ - 9'~
DATE PAID (~- I ;)... 0
AMOUNT RECEIVED $2 Le.
c:fW--J
RECEIVED BY