HomeMy WebLinkAboutPermit Building 1991-12-23 (2)
u ~~ 15
.. RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
.
SPRINGFIELD
.
JOB NUMBER
9//y~
225 Fifth Street
Springfield, Oregon 97477
LOCATION OF PROPOSED WORK: ?"9"":?"7
ASSESSORS MAP: /?~-::;;-27- V /
4. 9'. ?,;-E fr?1/?'Z- J0..:>
TAX LOT: ~ <>~~
SUBDIVISION'
LOT:
OWNER.
/A#~ #":!!>L~
-5,r,..L
?;P~ '-D_
/
Ad,9 " \-:. u\'\
ADDRESS:
CITY:
DESCRIBE WORK.
NEW REMODEL~ ADDITION
CONTRACTOR'S NAME
GENERAI'~
PLUMBING:
MECHANICAl'
ELECTRICAl.
QUAD AREA:
SR~)lA
. OF BLDGS.
OCCY GROUP:
. OF STORIES:
WATER HEATER:
BLOCK'
STAT".
Ai'n.
PHONF' ?C/&::-c:>3'/ T"
ZIP' &7') '9"::>"/
ADDRESS
CONST.
CONTRACTOR'
PHONE
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
rvl Rough Electrical - Prior to
~ cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D
Fireplace - Prior to facing
materials and framIng Insp.
zl
>(
~(JrhfL
EXPIRES
FLOOD PLAIN'
ZONING CODE:
. OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE: _' ln9.
To request an l~spectlon, you must call 726.3769. This Is a 24 hour recordIng. AI/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.
D Temporary Electric
lKJ Site Inspection - To be made
after excavatIon, but prior to
setting forms. ~i'f...
;>/H~,IfI . ";'r'1" VPiYff~/~...,..'
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
[K] Footing - After trenches are
excavated.
D
Masonry - Steel location, bond
beams, grouting.
C29 Foundation - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D
Underfloor Plumbing I Mechanical
- Prior to Insulation or decking.
o
Post and "Beam - Prior to floor
insulation or decking.
[K] Floor Insulation - Prior to
decking.
D Sanitary Sewer - Prior to filling
trench. "
D Storm Sewer - Prior to filling
trench.
D Water Line - Prior to filling
trench. .
[EJ Rough Plumbing - Prior to
cover.
DEMOLISH
OTHER
- OFFICE USE -
LAND USE:
III I .
. OF UNITS:
CONSTR. TYPE:
HEAT SOURCE:
RANGE:
IZJ
Framing - Prior to cover.
121 Wall/Ceiling Insulation - Prior to
cover.
G{] Drywall - Prior to taping.
D Wood Stove - After"installation.
D Insert - After fireplace approval
and Installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sidewalk & Driveway - After
excavation is complete, forms
and sub.base material in place.
D Fence - When completed.
o Street Trees - When all req"ui'red
trees are planted. ".. .
IZJ
Final Plumbing - When all
plumblngwo~iscompleta
~ Final Electrical - When all
electrical work I:;> complete.
D
Final Mechanical - When all
mechanical work is complete.
IX]
Final Building - When all
required inspections have been
approved and building is
completed.
DOther
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.
D Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
D
Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.
J
-
Lot faces
Lot sq. ltg,
Lot coverage
Topography
Total height
Lot Type.
Interior
Corner
Panhandle
C u I-d e-sac
BUILDING PERMIT
ITEM SO. FT. X $/SO_ FT.
Main
Garage
Carport
.1.P? 1~8
,If'''''r?;e:>I?CZ
Total Value
Building Permit Fee
State Surcharge
Total Fee (A)
..
"
~
. 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.
I PL.
IN
Is
Iw
IE
Setbacks
'HSE GAR'ACCI
I
I
I
I
VALUE
~-9'.~6
;z,~yp
~ -
7'1, s-,o.
;;;,73
7E.2?
SYSTEMS DEVELOPMENT CHARGE (SDC)
1/.1' '
PLUMBING,PERMIT
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
(B)
/
N'
FT
FT.
FT.
/?? //o/-
(C)
Dryer Vent
Wood Stove/lnsert/Fireplace Unit
N'
Mechanical Permit
Issuance
State Surcharge
Total Permit
Mobile Home
MISCELLANEOUS PERMITS
(D)
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
FEE
/&7,<>':>
/5.-=
_77
/5:- ::;::>,,5"
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
9::3.7~
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.
'Ie. 7'~
/2 )/6-"/,
Receipt Number' "??7/
/??..f'~~
Plan Check Fee:
Date Paid:
ReceIved By: ,
~ ~/.
'- ~-- '-- ~ ~
ns Reviewed E!y r
/:2-'<<:::>-9/
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 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 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 remain
on the site at all t~~structi~. ~
Signature ..y~~~~~ J
Date ~ -?3~/
VALIDATION:
-:? -;;? B" 2..
DATE PAin 1'2-<"7--9/
AMOUNT RECEIVED /"3L/ ,9"3
~~ -~.~-'?
'// --,
RECEIPT NUMBER
RECEIVED BY
~
~f
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
1. LOCATION OF INSTALLATION
?Q'37 ~~/"';';;:~'u, ,/fz::>
LEGAL DESCRIPTION
1'7 -&'~-'2 ~- 'T / _ c:>5'~c>
,
JOB DESCRIPTION
JP;;#i'/~ ~. 4zJZ>/7"/~~)
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
'180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Address
City
Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
".
)( s#~rv~Zian
~rs Name_[~HN .~L ~.
Address 29"37 4?#",,"e&-~~,
Ci ty .c:;;~.n:r. Phone 7.yt:~&P?/3
OVNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
DATE: /";;?~::z ~_ '7 /
RECEIPT II: '33B'2-
RECEIVED. BY: /:A'~.---c;__ =
OF ,. /'
S'.'IINGFII.::LD
City Job Number 4//7'5"9
3. COMPLETE FEE SCHEDULE BELOV
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
Items Cost Sum
1000 sq.ft. or less $ 85.00
Each additional 500
sq. ft or portion
thereof $ 15.00
Each Manuf'd Home or
Modular Dwelling
Service or Feeder $ 40.00
B. Services or Feeders
Installation, Alterations or
Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
$ 40.00
$ 55.00
$ 80.00
see "B" above
D.
Branch Ci rcui ts
New, Alteration or Extension Per Panel
One Circuit ,
Each Additional
Circuit or with Service
or Feeder Permit ~
$ 35.00 ~~~
$ 2.00 '-/. c-
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res $ 20.00
Limited Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
~"7. _b
t . "t-f?
4".0."9<;'