HomeMy WebLinkAboutPermit Mechanical 1995-6-28 (2)
RESIDENTIAL
PERMIT APPLICATION
-:.
Inspections: 726.3769
Office; 726-3759
LOCATION OF PROPOSED WORK'
ASSESSORS MAP:
LOT:
/ TZJ S
OWNER"
2 A-I PI-!
24~~2,
C/il\u
L L/ // /7"A
I-f / /1 \"
-
ADDRESS:
CITy:_.LAC/lA 1.4
DESCRIBE WORK:
NEW
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERA' .
PLUMBING'
,
-1
<':\ u (;l..., 1)(t?iJ
~ u fhJ>,() (~
MECHANICA' .
ELECTRICAl'
QUAD AREA:
. OF BLDGS'
OCCY GROUP'
. OF STORIES:
,
WATER HEATER'
SPRINGFIELD
'J ~"""
22-
(: A WI" j:: IJ. illY-,
~/
.
JOB NUMBER % / ()? 9
BLOCK'
225 Fifth Street
Springfield. Oregon 97477
i?rI
TAX LOT'
/') S- 7 crz>
SUBDIVISION'
PHONE:LS/O l_..,t?7 -/Qf?-.J:7,:
(7/4:1 ff~ -~ 7Sif-
C.A II .(rJOlrL-- ZIP' 9z~ s'"'r;.
REQUIRED INSPECTIONS
'1'71 Rough Mechanical - Prior to
~cover.
D Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrlcaf power.
o Fireplace - Prior to facing
materials and framing Insp.
o Framing - Prior to cover.
o Wail/CeIlIng Insulation - Prior to
cover.
o Drywall - Prior to taping.
D Wood Stovo - After Installation.
o Insert - After fireplace approval
and Installation of unit.
o Curbcut & Approach - After
torms are erected but prior to
placemont of concrete.
o Sidewalk & Driveway - After
excavation Is complete. forms
and sub-base material In place.
o Fence - When completed.
D Street Trees - When all required
trees are planted.
ADDRESS
CON ST.
CONTRACTOR'
PHONE
EXPIRES
1>40"39
L.I"l 3 - L.He
2../(7/-/1 r, (
.:-:?- - I.....
-, _ . ~ r.....
L./t'"./-77~"'"
FLOOD PLAIN:
ZONING CODE:_
. OF BDRMS'
SECONDARY HEAT:
SQUARE FOOTAGE:
To request an Inspection, you must carl 726-3769. This Is a 24 hour recording. Alllnspectlons requested before 7:00 a.m. will be
made the same working day, Inspections requested atter 7:00 a.m. will be made the following work day.
<)7:
STATE:
DEMOLISH
OTHER
o Temporary Electric
D Site Inspection - To be mado
after excavation, but prior to
setting forms,
o Underslab Plumblng/Electrlcall
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o Masonry - Steel location, bond
beams, groutlng,
o Foundation - After forms are
erected but prior to. concrete
placement.
o Underground Plumbing - Prior
to filling trench.
o Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
o Post and Beam - Prior to floor
Insulation or deckIng.
o Floor Insulation - Prior to
deckl ng.
D Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior to filling
trench.
o Water line -' Prior to filling
trench,
D Rough Plumbing - Prior to
cover.
- OFFICE USE -
LAND US".
. OF UNITS'
CONSTR. TYPE:
HEAT SOURCE:
RANG'"
o Final Plumbing - When all
plumbing work is complet,e.
'f:::71' Final Electrical - When all
~ectrlcal work Is complete,
r-xr Final Mechanical - When all
~eChanical work Is complete.
o Final Building - When all
required Inspections have been
approved and building I.
completed.
.l8:[ Other k'lOV<i" H .:VA-."
~ t7~ ,,~/,..,::
MOBILE HOME INSPECTIONS
o Blocking and Set.Up - When all
blocking Is complete.
o Plun:tblng 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.
HSE GAR Accl
I
I
Iw I \ I
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Lot faces
Lot Type _
Interior
I P.L.
IN
\S
Lot SQ. fig.
Lot coverage
Corner
Topography
Total height
Panhandle
Cul-de-sac
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT.
VALUE
MaIn
Garage
"
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fec
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT.
FT.
FT.
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
h?/-/ J
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsertl Fireplace Unit
Dryer Vent
C;;A-<: L/"..J~
,QJ/AJ,
J.~t90
/,F) .~
1.2-<J
./.h..2.0
Mechanical Permit
Issuance
State Surcharge 1.7 >" -,J-~~..r
Total Permit (D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
fI
Curbcul
ft
Demolition
State Surcharge
Total Miscellaneous Permits
(E)
TOTAL AMOUNT DUE (excluding electrical) .? ~2...0
(A, B, C. D, and E Combined)
;~:!.: ~.,: :~;: .
;,/ ".
.:HE PROPOSED WORK IN THE.
....HISTORICAL DISTRlcr, OR ON
THE HISlORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
Setbacks
APPROVED' .
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
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
5L;#~~ ~ ~..&- f , L?e-Y /n//
/<'&'~D'
By signature, I stale 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 Stato of Oregon pertaining to tho work described
herein. and that NO OCCUPANCY will be made of any
structure without permission of Ihe Building Safety Division.
I further certlfy 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
::"~~:2:'~~Z: j?~.
Date 0'/.2~S- {/
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
RECEIVED BY