HomeMy WebLinkAboutPermit Building 1995-6-21
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
o trice: 726.3759
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JOB NUMBER ~~."?:?~
225 Fifth Street
Springfield, Oregon 97477
LOCATION OF 'PROPOSED WORK' '1'/3 /~~I--r~Js...-- (~V::?:>
ASSESSORS MAP: 1?-o?-7Y-/'/ . TAX LOT:~~"';>~
OWNER' T~~~ ~Hs(E:S-
ADDR~""" (/41? 19/~I//~ &:.V.D
..-5Z>r:>Lb. . ' STAT~' ~ .
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DESCRIBE WORK: ft~'/""'/~c.rc:.7'-~~~'~r- ~
NEW REMODEL ADDITION DEMOLISH OTHER
LOT:
CITY:
CONTRACTOR'S NAME
GENERAl' ~WA-~. =:'_
.' ;
PLUMBING'
MECHANICA"
ELECTRICAL:
BLOCK'
SUBDIVISION:
PHONE:
726-"5'~<9
~#/'7-r/'?.:i> ~
<<9 :::>q:, ""::>
ZIP:
5:~ ~.<
ADDRESS
CON ST.
CONTRACTOR'
, ,
- OFFICE USE -
LAND USE: ,,\ \
. OF UNITS:
CONSTR. TYPE:
HEAT SOURCE:
Vf\J
EXPIRES
PHONE
/'
QUAD AREA: \~'L...)
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. OF BLDGS:
,4
~
OCCY GROUP'
lv\'
. OF STORIES:
WATER HEATER'
RANGE: _
FLOOD PLAIN'
ZONING CODE:~
. OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE: A2.1o
/""
To request an Inspection, you must call 726.3769. ThIs Is a 24 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.
o Temporary Electric
o Site Inspection - To be made
after excavallon, but prior to
setting forms.
o Underslab Plumblng/Electricall
Mechanical - Prior to cover.
m Footing - Atter trenches are
t..tp::.J excavated.
D Masonry - Steel location, bond
beams, grouting.
rY=l Foundation - After forms are
~ erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench,
o
UnderUoor Plumbing/Mechanical
- PrIor to insulation or decking.
D
Post and Bea~ - Prior to troor
Insulation or deckIng.
D
Floor Insulation - Prior to
decking.
O Sanitary Sewor - Prior to tilling
trench.
~
o
Storm Sewer - PrIor to filling
trench.
Water Une - PrIor to filling
trench.
D Rough Plumbi~g - Prl'!f.to
cover. . .
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
D Rough Eleclrlcal - Prior to
cover. .
o Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - PrIor to facing
materials and framing Insp.
~ Framing - Prior to cover.
D Wail/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
D Wood Slovo - After Installatl::,n.
D Insert - After fIreplace approv~1
and Installation of unit.
D Curbcut & Approach - After
forms are erected but prior to
placemont of concrete.
D Sidewalk & Driveway - After
excavation is compiete, forms
and sub-base material in place.
D Fence - When completed.
D Street Trees - When all r~qulred
trees are planted. ~.
~
D
Final Plumbing - When all
plumbing work is complet,e.
Final Electrical - When all
electrical work is complete.
o Final Mechanical - When all
mechanical work Is complete.
m Final Building - When all
~ required inspections have been
approved and building is
completed.
DOther
MOBILE HOME INSPECTIONS
D Blocking and Set.Up - When all
blocking Is complete.
D Plumbing Connections - When
home has been connected to
water and sewer.
o Electrical Connection - When
blooklng, 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.
-'_-&.l~ --
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SYSTEMS DEVELOPMENT CHARGE (SDC~
~ ~?:::
BUILDING PERMIT
ITEM SQ, FT., X $/SQ, FT.
Main
Garage
Carport t./2~ :$.A?
~ 7~ ,$?X/iP,.;'~
Total Value
Building Permit Fee
State Surcharge
'J..\3~\.8~
Tolal Fee
(A)
.....,.
PLUMBING PERMIT
.ITEM
Fixtures
Residential Bath(s) N'
Sanitary Sewer FT,
Water FT,
'" Storm Sewer ~ 5'0 r
~
Mobile Home
Plumbing Permit
State Surcharge /.2..'- -r, 7-'
Total Charge (C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsert/Flreplace Unll
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
Stale Surcharge
Sidewalk
ft
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B. C, D, and E Combined)
VALUE
"
_' 1...\, 362_
/~~9
FEE
::zs.~
2~
-2;?,PtO
95
c-;
9~.s.1.
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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 cOl')struction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances,
Plan Check Fee:
~.77
~
~-:<f-~5
Date Paid:
Receipt Number:-!f4"'B/,
Received By: ::.;~
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Piahs..E,eviewed By
rJ..o.\I~~
, D~e
Systems Development Charge is due on all undeveloped
properties within the City limits which are being Improved,
ADDITIONAL COMMENTS
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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 Ordinanc~s 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
arc 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 II es during constructi~ /J
Slgnatur aJ< p, ~7L;,
Date I - ?J.qS '.
VALIDATION:
RECEIPT NUMBER 0 ( r]q(j{1
DATE PAID Lt {~ ( (Oft-{
AMOUNT RECEIV~rlJ :~.'ll.{~ SI
RECEIVED BY ~JAJ..h