HomeMy WebLinkAboutPermit Building 1996-4-2
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
.
LOCATION OF PROPOSED WORK:~S ~C:;f:L.!1(}l 1 naP
ASSESSORS MAP: / /t!/ ?' - <6 . =<. 3"
LOT'
BLOCK:
OWNER:
ADDRESS'
CITY:
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(0';- S;-h40y J..DDfJ
,C; PR I k):, PUf~tJ STAT~'
012.
.
JOB NUMBER ....5!~tP Yt:::;'/
225 Fifth Slreel
Springfield, Oregon 97477
.
C:;f!.I2..JfJGFlEJ.O) nO,
TAX LOT' ~~C>'9
SUBDIVISION'
,
PHONE: 2'-1 1)- S?) J. J
ZIP:
CJ f) Jf 1)1)
DESCRIBE WORK: -..;r~;/'f~? ,r;;~/?7~ p~ .;1 ~7/A~<!.-.. 5" .t>??e>.MJ~....
NEW REMODEL ADDITION DEMOliSH OTHER
CONTRACTOR'S NAME
GENERAl .1/A.tV ~4:-
-" .. ,
CaNST.
~~~SS ~A''<: C CONTRACTOR' EXPIRES
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. /- ~ r '/ -,.
PHONE
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PLUMBING:
MECHANICA' .
ELECTRICAL:
- OFFICE USE -
QUAD AREA: LAND USE: FLOOD PLAIN:
. OF BLDGS: . OF UNITS' ZONING CODE:_
OCCY GROUP' CONSTR. TYPE: . OF BDRMS:
. OF STORIES' HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGE: SQUARE FOOTAGE:
To request an InspectIon, you must call 726-3769, ThIs Is a 24 hour recording. All Inspections requesled 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 SHe Inspection - To be mado
after, excavation, but prior to
setting forms.
D Underslab Plumbing/Electrical I
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
D Mas~nry - Steel location, bond
beams, grouting.
D Foundation - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
D Floor Insulation - Prior to
decking.
o Sanllary Sewer - Prior to filling
trench. .
D Storm Sewer - Prior to filling
trench.
D Weter Line - Prior to filling
trench.
D Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
D Rough Electrical - Prior to
cover.
D Electrical Service - Must be
approved to obtain permanont
electrIcal power.
D Fireplace - Prior to facing
materials and framing Insp.
IZJ FramIng - Prior to cover.
D Wail/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
D Wood Stovo - After Installation,
D Insert - After fireplace approval
and Installation of unit.
D Curbcut & Approach - After
forms are erected but prior 10
placement of cone rote.
D Sidewalk & Driveway - After
excavation Is complele, forms
and sub.base material In place.
D Fence - "Vhen completed.
D Streot Trees - When all required
trees Bre planted.
D Final Plumbing - When all
plumbing work Is complete.
o Final Electrlcnl - When all
electrical work Is complete.
D Final Mechnnlcel - When nil
mechanical worl< 15 complete.
1.71 Final Building - Whep nil
~ required Inspections have been
approved and building Is
completed.
DOthor
MOBILE HOME INSPECTIONS
D Blocking and Set. Up - When all
blocking Is complete.
D Plumbing Connections - When
home has been connected to
waler 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
venlln.g have been Installed.
Lot faces 'Lot Type.
Lot sQ. ftg. Interlor I P.L.
IN
Lot coverage Corner Is
Topography Panhandle Iw
Total height Cul.de.sac IE
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT.
VALUE
Main
Garage
"
Carport
'. .1.',
ts THE PROPOSED WORK iN THE.
'HISTORICAL DISTRICT, OR ON
THE HISTORtCAL REGISTER?
II yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
. ~':
Setbacks
HSE GAR Accl
I
I
Tolal Value -:;? ~c>. -C-
/J.-.;r/./. /_..60-
Building Permit Fee JF'/?p-.?- /~-
~"2 '-?1?~
State Surcharge r ~ V;5'
Total Fee (A) /C . 2~
SYSTEf-:'lS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
tTEM
FEE
Fixtures
Residential Bath(s)
Sanitary S~wer
Water
N'
FT.
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(e)
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
N'
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
Slate Surcharge
Totat Mlscetlaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C. D, and E Combined)
/6
~
APPROVEC"
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 tho 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: #-.4_
Date Paid:
Receipt Number:
Received By:
Plans Reviewed By
Date
Systems Developmen.t 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 carofully examined
the completed application and do hereby certHy 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 Ordlnancos of the City of Springfield. and the Laws
of the Stale 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.
Slgnalu're
Date.... ./
,
ij- .:2 -
VALIDATION:
RECEIPT NUMBER
-:;?o"?2f5
V-?'''5}:::;
/b. ":?~
~~
DATE PAIl'
AMOUNT RECElv"n
RECEIVED BY
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