HomeMy WebLinkAboutPermit Building 1998-4-14
RESIDENTIAL
PERMIT APPLICATION
Inspections: 72&3769
Office: 726.3759
.
LOCATION OF PROPOSED WORK: ~351 0 ~,(,\P..l \ (In.Lr.\.
ASSESSORS MAP: /?-Al ~- ::?'/-:? 2.. '
OWNER' ~"o..r1"l..1 ,\~
ADDRESS: ' ~3slo Q c:.A ~\ (' Orv....r \-
CITY: ~\~~ \0 STATE: r::xl{jcf\
DESCRIBE WORK: V'~Io.~l'l\ vi.~It'\("\'\ (')\, Q..")('C"ll.tl (":'\-\.-'00.. 1S:0CX2...6.TO
REMODEL \I ADDITION DEMOLISH
"
'.
LOT'
NEW
CONTRACTOR'S NAME
GENERAL: ~\~... ~
PWMBIN'"
MECHANICAl'
ELECTRICAl'
.
BLOCK'
OTHER
.
JOB NUMBER ~~~
225 Fifth Street
Springfield, Oregon 97477
~\rl q14ll
." TAX LOl' c;:::> =?? =
SUBDIVISION'
PHONE: ~n-ll5'C4
ZIP: Qil.\"l"l
~'J. oo...'~"ln'Yl.t.'"'
V
ADDRESS
4lo'\D f'f\t1i ~m d-
CON ST.
CONTRACTOR '
CC65lPlS~
EXPIRES 0 PHONE
;lOOb f'&-' ilp'}7
- 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 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
o Temporary ~Iectrlc
O Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab,Plumblng/Electrlcel/
Mechanical - Prior to cover.
o Footing - After trenches are
. excavated. .
o Masenry - Steel location, bond
, ,beams, grouting. .
o Foundation - After forms are
erected but- prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
O Underlloor PlumbIng/Mechanical
-,Prior to Insulation or decking.
o Post and Beam - Prior to floor
Insulation or- decking.
o Flo!)' Insulation -. ~rlor to
decking.
o Sanitary Sewer - Prior to flillng
trench.
o Storm Sewer - Prior to ff1l1ng
trench. .
o Water Line - Prior to filling
trench.
D Rough Plumbing - Prior to
cover.
rn Rough Mechanical - Prior to
~#6~
[] Rough Electrical - PrIor to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
o Framing - Prior to cover.
o Wail/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping.
o Wood Stovo - After Installation.
D Insert - After fireplace approval
and Installation 01 unit.
:,: ~ ;.
D.Curbcut & Approach - After
. . . forms are €!rected but prior to
I t placemont of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and'sub-base material I" place.
o Fence - When completed.
D .Street Trees - When all required
trees are planted.
o Final Plumbing - When all
plumbing W9rk Is complet!'.
D Final Electrical - When all
electrical work Is complete.
ILSl Final Mechanical - When all
mechanical work Is complete.
y r~ C;!>
o Final Building - When all
required Inspections have been
approved and building Is
completed.
[E] Other C~ -:(~I..-
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.
o Electrical Connection - When
blocking, 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
porchos, skirting, decks, and
venting have been Installed.'
,
Lot faces
Lot sq. ltg.
Lot coverage
To pography
Total helghl
,
,'.
Lot 1ype
Interior
Corner
Panhandle'
-.
, : ~ Cul-de-sac
BUILDING PERn1lIT:~"~ 'i
ITEM sa. FT. x $/SO. FT. =
Main
. .
Garage
Carport
"
Total Value
Building Permit Fee
State Surcharge
. .,' ~
Total Fee
(A)
Setbacks .
. HSE . GAR' ACe' I
I
I
.:1
I
BUILDING v'hLaE, PLAN CHECK
AND BUILDING PERMIT
I P.L.
IN
Is
,Iw
IE
VALUE
"
SYSTEMS DEVELOPMENT CHARGE (SDC)
PLUMBING PERMIT
ITEM
Fixtures
Resldenllal Bath(s)
N'
Sanitary S~wer
Water
FT,
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
Slate Surcharge
Total Charge
(B)
(C)
MECHANICAl. PERMIT
Furnace q~
Exhaust Hood
Vent Fan
N'
Wood StovellnsertlFlreplace Unit
Dryer Vent
'/'A~ c;.<:.r;r' ',',~
/,.,~ /~ ....,,- ...
.., . ". n_~
~ -'- ... (' '-
MechanIcal Permit
Issuance
State Surcharge
Total Permit (D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
It
Curbcut
Demolition
State Surcharge
Total Miscellaneous Permits (E)
FEE
~/#, /~.-
/P.~
B- :~
2.t1!:.20
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C. 0, and E Combined)
" :~\:1~_~:i~,,~\-
.
( tS THE PROPOSED WORK IN THE " '
""HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
II yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
"
APPROVl=n.
This permit Is granted on t~e;express condlt[on that the said
construction shal!, In all respects. conform to the Ordinance
adopted by the City 0.1 Springfield, ,Including the
Development COde"regulatlng the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordlnan'ces.
." '
;Plan' Check Fee'
. , , ,.
Date Paid:
Receipt Number'
Received By:
, ,
.,
.'"
Plans RevIewed By
Date
Systems Development Charge Is due on all undeveloped
properlles within Ihe City limits which are being Improved,
ADDITIONAL COMMENTS
By signature, I state and agree, that I have carefully examined
the completed appllcallon 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 aiall times dUrl~gf~truG\101I,
Signature t lW\\ 1 R ,~ ~
4-14-QX .
Date
VALIDATION:
RECEIPT NUMBER :::Z9o/..::?c::;;"
DATE PAir 'Y-/q .~t2.
AMOUNT RECEIVED ~::?e::'
RECEIVED BY _&~
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