HomeMy WebLinkAboutPermit Building 1998-6-10
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK' if 1- "
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ASSESSORS MAP'
LOT'
BLOCK:
OWNER: if 0 N ;= r' /'5 G' /--( ):? I? #- L
ADDRES~" Lf'7 5- jf,'cJPIC U,'~ LV
CITY: ~r' t' W,I L" J (. J
De e-f::
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STATE: /91"'"
DESCRIBE WORK'
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NEW
REMODEL
ADDITION
DEMOLISH
OTHER
-
1fo 6 r ~
JOB NUMBER
225 Filth Street
Sprlnglleld, Oregon 97477
TAX LOT:
SU8DIVISION'
11730
I
PHONF'
5'"Cf 1- 7 V 7-72C6-
ZIP:
77</7/
CONTRACTOR'S NAME
ADDRESS
CONST.
CONTRACTOR'
EXPIRES '.-:'> PHONE
GENERA' .
PLUMBING'
MECHANICA' .
ELECTRICAl'
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMM~Nr.F.D OFlI~ ARANn()N~n r:1'\1:l
ANY 160 DAY PERIOD. - OFFICE USE -
QUAD AREA'
· OF BLDGS:
OCCY GROUP'
. OF STORIES:
LAND US~'
. OF UNITS:
CONSTR. TYPE:
HEAT SOURCE:
WATER HEATER'
RANGF'
FLOOO PLAIN:
ZONING CODE:
. OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE: __
To request an Inspecllon, 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.
REQUIRED INSPECTIONS
D Temporary Electric
D Rough Mechanical - PrIor to
cover.
D Slto Inspection - To be mado
after excavation, but prior to
setting forms.
D Rough Electrical - Prior to
cover.
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
D Electrical Service - Musl be
approved to obtain permanent
electrical power.
D Footing - After trenches are
excavated. D Fireplace - Prior to facing
. materials and framing Insp.
D Masonry - Steel location, bond rf6 )
beams grouting. 19J
. . D F.ramlng - Prior to cover.
D Foundation - After forms are
erected but prior to concrete D Wail/Ceiling Insulation _ Prior to
placement. cover.
D Underground Plumbing - Prior
to filling trench.
D Drywall - Prior to taping.
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Wood Stovo - After Installation.
D Post and Beam - Prior to floor
Insulation or decking.
o Insert - After fireplace approvlJ,1
and Installation of unit.
D Floor Insulation - Prior to
decking, .
D Curbeut & Approach - After
forms are erected but prior to
placement of concrete.
o Sanitary Sewer - Prior to filling
trench. .
D Storm Sewer - Prior to Hlling
trench.
D Sidewalk & Driveway - After
excavation Is complete, forms
and sub.base material In place.
D Water Line - PrIor to filling
trench.
D Fence - \Nhen cOfr'lpleted.
D Rough Plumbing - Prior to
cover.
D Street Trees - When all required
trees are planted.
D Final Plumbing - When all
plumbing w9rk Is complet.e.
D Final Electrical - When all
electrical work Is complete.
D Final Mechanical - When all
mechanical work Is complete.
D 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 .'3.nd 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.
."
Lot ~ype. .
.' ,
Lot faces
Lot sq. fig. Interior I PL.
IN
Lot coverage Corner
Is
Topography Panhandle 'f
Iw
Total height Cul-de,sac
IE
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BUILDING PERMIT "
.'
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1;1 'J
Setbacks
'HSE'GARJACdl
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I
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BUILDING VALOE, PLAN CHECK
AND BUILDING PERMIT
ITEM
sa. FT.
X $/so. FT. =
VALUE
Main
Garage
'.
Carport
ffD-L
/{Ou
IJ !:eJ{
l<t'tJMrL
Total Value
Building Permit Fee
.1j I. its
,
State Surcharge
Total Fec
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Balh(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
N'
Wood StovellnsertlFlreplace Unit
Dryer Venl
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
fI
Curbcut
fI
Demollllon
State Surcharge
Tolal Miscellaneous PermllS (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
IS THE PROPOSED WORK IN THE.
'''HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this appllcallon must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
APPROVED:
This permit is granted on the express condition that the saId
constructlon shall, In all respects, conform to the Ordinance
adopted by Ihe 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
Dale
Systems Development Charge Is due on all undeveloped
properties wlthln,the City limits which are being Improved.
"
. '. . I
ADDITIONAL COMMENTS
.... '.J
By signature, I stale 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 cerllfy
that any and all work performed shall be done in accordance
wllh the Ordinances of the City of Springfield, and the Laws
of Ihe State of Oregon perlalnlng 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 Ihe street, that the permit card Is located at the front
of Ihe property, and the approved set of plans will remain
on the slte~t rt:es during construction.
SA -.5<-
Ignaturp":
Datp r;~;o - 7-/
VALIDATION:
RECEIPT NUMBER
DATE PAIr>
AMOUNT RECEIVED
()3o 2 Lf r-
~ If'; / C( f
/(;. 2 0 /J
/A 'f/ ,tJ evJ/
RECEIVED BY