HomeMy WebLinkAboutPermit Building 1999-11-23
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK: ~
17()~ 2t;/1
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OWNER: ~ }eAkIAI) fJ.O JI(~IKJ
ADDRESS: .~~ ~ 2- 2. 2-
- <::'A{2tc!
I
DESCRIBE WORK: ~M.s A (I/tuv( tJ~
.' ' '.., Q #
NEW REMODEL ADDITION DEMOLISH,
ASSESSORS MAP:
LOT:
CITY'
CONTRACTOR'S NAME
t? (rI A/-t:7t.---
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GENERAl.
PLUMBING'
MECHANICAL:
ELECTRICAl'
BLOCK:
i.,
JOB NUMBER 180/111 -".
225 Fifth Street
Springfield, Oregon 97477
TAX LOT: t3 / / C:l 0
SUBDIVISION:
IZ..
5-rtt<J-
PHONF' 7J.Pf-S~:;L
/~6- (/06S
~e ZIP: Cf?-'t77
STATE:
-,
'OTHER
ADDRESS'
CON ST.
CONTRACTOR #
EXPIRES;~ PHONE
- OFFICE USE -
QUAD AREA' LAND USE: FLOOD PLAIN:
# OF BLDGS' # OF UNITS: ZONING CODE:
OCCY GROUP: CONSTR. TYPE: /I OF BDRMS'
# OF STORIES' HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGF' SQUARE FOOTAGE:
To request an Inspection, you must call 726-3769. This Is a24 hour recording. All 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.
D Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - PrIor to cover.
o Footing - After trenches are
excavated. .
. D Masonry - Steel location, bond
beams, groutIng.
D Foundation - After forms are
erected but prIor to concrete
placement.
D Underground Ph~mblng - Prior
to filling trench.
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Post and Beam ~ Prior to floor
Insulation or decking.
D FloorlnsulatJon - Prior to
decking. ' J
D Sanit~ry Sewer - Prior to filling
. trencli. .
D Storm Sewer - Prior to mllng
trench. " , .,. ,. "
....., "j ". -j :
D Water Line - Prlo,r tl? f~"lng
trench. . iI, ." ",
. "
D Rough Plumbl.n; -prior to
cover. : '., '.
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
D Rough Electrical -,. Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
7). terlals and framing Insp.
~ramlng - Prior to cover.
o Wail/Ceiling Insulation - Prior to
cover. .
D Drywall - Prior to taping.
o Wood Stovo - After Installation.
o Insert - After fireplace approval
.. and Installation of unit.
r- - ~.
,_ 0 Curbcllt & Approach - After
forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
o Fence. - When completed.
o Street Trees - Wh~n ~1I,requlred
trees are plal)ted. .
f
D Final Plumbing - When all
. plumbing w9rl< Is complete.
D Final Electrical - When all
electrical work Is complete.
o Final Mechanical - When all
.u;;2meChanlcal work is complete.
nal 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.
o 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
porchos, skirting, decks, and
venting have been Installed,
Lot faces
Lot Type'
Leot sq. ftg.
Interior
Lot coverage
Corner
Topography
Total height
..
panhandle ..
Cul-de-sac
BUILDING PERMIT 'I "
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'r,'J" -, ,O't . >.' 'tf1' ~ :". .oft \' .
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Setbacks '
HSE GAR ACC'
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IS THE PROPOSED WORK tN"ft.fi:;'. .
"HISTORICAL qlSTRICT, OR ON
, THE HISTORICAL REGISTER?
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IN
Is
If yes, .this aPlplleatlon must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
'1
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BUILDING \ni.tCiE,PLAN 'CHECK
AND BUILDING PERMIT
w
E
APPROVED:
ITEM SO, FT. X $/SO, FT. VALUE
Main
Garage "
',,'r
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
~ ~.Sb
,-
l.t.)
This permit Is granted on the express condition that the said
construction shall, Inali respects, conforn'1'to the Ordinance
adopted by the City. of Springfield, Including the
Development Code, regulating the constru,ction and use of
oulldlngs, and may be suspe'nded or revoked at any time
upon violation of any provlslons.of said ordinances.
Plan Check Fee: 'Lt: 0 ~
Date Paid: ," I.z.l'/' ',7
-, .
Receipt Number'
Received By: . 'A
dU~
Plans Reviewed By
II /1!.~/77
Date
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
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
NO
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
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, S, C, D, and E Combined)
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
FEE
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 cohect, and I further certify
that any and ali 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, an e approved s~t of tans will remain
on the site at time during c~n~t c:,o) 0
Slgnaturp ~~ ~ WU
~ \ ",,---..--' .
Date / I-~ ~ 3 - t?t.CJ
VALIDATION:
RECEIPT NUMBER
DATE PAID
()3'7-72-
1,/l.J!f,
I
/7 Jf f
~ tJJ
,7,3~
AMOUNT RECEIVED
RECEIVED BY
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W\~ ~+11
ATTENTION:Oregon law requires. you to
follow rules adopted by the Oregon Utility
Notification Center. Those mlesare set forth
in OAR 952-00'1-001 0 through OAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note:.t~~e tel?~ho~e
number for the Oregon Utllny NOllflcatlOn'
Centsr is 1-800-332-2344).
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NOTICE: --..
THIS PERMIT SHALL EXPIRE IFTHEWORK
AUTHOR'LtuUNDERTHIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
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