HomeMy WebLinkAboutPermit Mechanical 8-5-26
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office,: 726-3759
.
LOCATION .oF PROPOSED WORK:
, '70 ;?-? '
ASSESSORS MAP' / J ,'i 2- 2-
, ,
t:; 7 -7 C;;
'-'" ,
"t <.(
G-
LOT:
;
BLOCK:
OWNER'
ADDRESS'
CITY'
l<ff-f( LA l3 /Ud' In
" ',$"' '1 -, S" a..G- <i J' f,e &'(
S/O/~j7vGF/)c td
v
()~,
(f) F h ovf /IJ U Mutt)
v .
STATE:
DESCRIBE WORK:
,rN,~rA, L(~~tJ,
NEW
REMODEL
CONTRACTOR'S NAME
GENERAl'
PLUMBING:
MECHANICAl'
ADDITION
DEMOLISH
. ,--..-------
, , J'OB NUM~-:'~-_'~ 0 t' 2;0
, 225 Fifth Street
Springfield, Oregon 97477
" TAX. LOT;
J"' 1'\
004-2~
SUBDIVISION:
PHONE:
7 V-l- k-~<t 0
4- 3'j - J"'I-~o
Cf 7 V7~
ZIP:
OTHER
ADDRESS'
CONST.
CONTRACTOR #
EXPIRES,:::,!_, PHONE
1..fM. tJo/ r.--{./F?,<lC64,.
ot 0,/ $" N (/ V Oe;- ~A-4/
,. 1= tJ{;.enjc / O~_ "17lto..~
ELECTRICAL:
QUAD AREA:
- OFFICE USE -
NOTICE: LAND USF'
# OF BLDGS: Trii5 t"t:HMI' ::iHAlL EXPIRE~~ THt~n~K
OCCY GROUP: ---AtffL.---. CONSTR. tv15l:::
, " flVrtu.I:U'UI~uER THIS PERMIT IS NOT
# OF STORIES: -OOMMENCejj GN IS ABAN~O~EB9=~~CE: "
WATER HEATER:.4,NY1BO DAY PERIOD. RANGE:
77
.,to-J j;.9J'
7 t..t 6-{6J.j
,FLOOD PLAIN'
ZONING CODE:
# OF BDRMS:
SECONDARY HEAT:
SQUARE Fo.OTAGE:
To request an Inspection, you must call 726-3769. This Is a24 hour recording. AI/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.
REQU IRED I NSP ECTIO NS
D R~ugh Mechanical ~ Prior to
cover.
D 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 fll/lng trench.
o Underlloor Plumblng/l\llechanlcal
-, Prior to Insulation or decking..
o Post and Beam - Prior to floor
Insulation or decking.
D Floor Insulation ..,... Prior to
, decking.
D Sanitary Sewer - Prior to filling
trench. '
D Storm Sewer -:- Prior to filling
trench. '
,0 Water Line - Prior to filling
trench. ,,' l.
I', \ .
D Rough Plu!TIblng - Pr!~r ,to
cover. \ ,.' '
o Rough Ehilctrlcal ...,. Prior to
cover. ..
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
D Framing '- Prior to coyer. ('
o Wal//Celllng Insulatlol1 - Prlorto
cover.' _
D Drywall - prl.or to taPing:'
o Wood Stovo - After Installation.
D Insert - After fireplace approval
,and Instal/atlon of unit. '
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sidewalk & Driveway - After
, excavation Iscom,piete,f9rms
ahd.'sub-basematerial In place.
o Fence:-:- When completed. .
o ,St~eet Trees - When aI/required
, trees a,re planted. " . ,
o Final Plumbing - When aI/
plumbing w9rl< Is complete. '
D Final Electrical - When aI/
. electrical work Is complete.
Wnal Mechanical - When aI/
~~chanlcal work Is complete.
D Final Building - When aI/
'required Inspections have been
approved and building Is .
completed.
DOther
MOBILE HOME INSPECTIONS
D Blocking and Set-Up - When aI/
bl~cklng 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 Instal/ed.
Setbacks .
I P.L. -/ HSE I GA'AT ACC
I N I I I
I S I I I
/W I I I I
IELL.~
", ' '/
BUILDING VALtlE, PLAN CHECK
AND BUILDING PERMIT
Lot faces
.'
'~:'
'. .~. .~
Lot Type
Lot sq. ftg.
Interior
Lot Coverage
Corner
Topography
Total height
,
Panhandle '
Cul-de-sac
BUILDING PERMIT 'i'/
ITEM SQ. FT.
,'i) '~
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
: ~ '" .r' . :
'S"",.
" .,: ! ': i;~;~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.
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.
FEE
ADDITIONAL COMMENTS
Fixtures
Residential Bath(s)
N"
Sanitary S~wer
Water
FT.
FT.
FT.
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N"
Wood Stovellnsert/Flreplace Unit
Dryer Vent
J/&vL(J~ ~
Mechanical Permit
/5. DD
Issuance
/0, /)0
,7:!' " its
1-c'~2D
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
ft
Curbcut
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D,' and E Combined)
.;
By signature, I state and agree, that I have carofully examined
the completed application and do hereby certify that aI/
Information hereon Is true and correot, and I lurther oertlfy
that any and all work performed shal/ be done In accordanoe
with the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertaining to the work described
here'ln, and that NO OCCUPANCY will be made of any
structure without permission of the SuI/ding Safety Division.
I further certify that only contractors and employees who
are In compl/ance with ORS 701.055 will be used on this
prOject.
I further agree to Elnsure that aI/ required Inspections are
requested at the proper time, that each address !s readable
from the street, that the pormlt card Is located at the front
of the property. and the approved set of plans WI~I/ remain
on the site at fi) tim~s .durl~col)G~ ~'
(;Pjn -,0, U~ P, ~ CC
Signature /~ ~ Y1A-<..e ,
v.
s-:. d-tP - '1 J"
Date
VALIDATION:
RECEIPT NUMBER
03002-0
~/).7-/7<j
. 2-(". z.r) I
AfI tv tNvcl
DATE PAID
AMOUNT RECEIVED
RECEIVED BY