HomeMy WebLinkAboutPermit Building 1991-7-5
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
-.
SPRINGFIELD
LOCATION OF PROPOSED WORK' -;:;t::} ~ -=<..
ASSESSORSMAP: \ I) ()~ 8l 0 \ \
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LOT.
OWNER:
ADDRESS'
CITY'
DESCRIBE WORK'
NEW
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERAL: L(->(J - ;, , "c..~
PLUMBING' tV Ill-
MECHANICAl'
ELECTRICAL:
QUAD AREA: A R \\ JuJ
. OF BLDGS' - -\.
\<:~
t
OCCY GROUP:
. OF STORIES:
WATER HEATER.
BLOCK'
'\l'lr
STATF'
oR
..
JOB NUMBER...!3..J P ~)
225 Fifth Street
Springfield, Oregon 97477
t:w-.
TAX LOT:
nR:J. !). ~
- At'l~ fo.. yy-o,
Y DEMOLISH
'D",",
SUBDIVISION:
PHON".
/41.-.. :s~o'?-
OTHER
ZIP' qJ'-I,/
ADDRESS
(~~t ~=<.c::-
N.
CONST.
CONTRACTOR .
?, #J JJ.Q.kv ,:,,6.." a
PHONE
3. /g 2 ctcts .1'01 .7
- OFFICE USE -
\ \ \ \
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CONSTA. TYPE: V A.J
LAND USE:
. OF UNITS'
HEAT SOURCE:
RANGF'
EXPIRES
~..;;J.Q~.::l
FLOOD PLAIN.
ZONING CODE: ~ .
. OF BDRMS: f\ jD..-J
SECONDARY HEAT'
SQUARE FOOTAGE: d5<n
TO request an inspection, you must call 726-3769. This Is a 24 hour recordIng. Alllnspectlons 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 excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical!
Mechanical - Prior to cover.
IZf Footing - After trenches are
excavated.
D Masonry - Steel location, bond
beams, grouting.
dJ Foundation - After forms are
J,6J erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
o
Underfloor Plumbing/Mechanical
- Prior to Insulation or decking.
~
Post and Beam - Prior to floor
Insulation or decking.
~ Floor Insulation - Prior to
~ decking.
D Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench.
D Water Line - Prior to filling
trench.
D Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
NROU9h Electrical - PrIor to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
~raming - Prior to ~over.
~all/ceiling Insulation - Prior.to
cover.
~DrYWall - Prior to tapln9.
D Wood Stove - After installation.
o Insert - After fireplace approval
and Installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material In place.
o Fence - When completed.
D Street Trees - Whem all required
trees are planted.
D Final Plumbing - When all
plumbing work Is complete.
~ Final Electrical - When all
electrical work is complete.
D Final Mechanical - When all
mechanical work Is complete.
jgJ Final Building - When all
required inspections have been
approved and building is
completed.
o Other
MOBILE HOME INSPECTIONS
o Blocking and Set.Up - When all
blocking is complete.
D Plumbing Connections - When
home has been con nected to
water 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, Skirtfng, decks, and
venting have been installed:
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
BUILDING PERMIT
ITEM SO. FT.
Main
Garage
Carport
If"m'Q""
Q~O
) Lj v.. ~()
Total Val ue
Building Permit Fee
State Surcharge
Total Fee
.
Lot Type
Interior
Corner
Panhandle
Cul-de-sac
X $/SO. FT.
(A)
I P.L. I
IN
Is
Iw
IE
I
HSE GAR ACC
Setbacks
.THE PROPOSED ~ORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
VALUE
11., 1/ l:, 0"
'1:<".>0
Cf. ~-;
crT I 3
SYSTEMS DEVELOPMENT CHARGE (SDe)
N/A
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) NO
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
Mobile Home
Plumbing PermIt
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
(B)
(C)
Dryer Vent
Wood Stove/Insert/Fireplace Unit
N'
Mechanical Permit
Issuance
State Surcharge
Total Permit
Mobile Home
MISCELLANEOUS PERMITS
(D)
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
FEE
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electriCal);P( C/7. ( 3
(A. B, C, D, and E Combined)
APPROVED'
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 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:
. (,..n...:I~.
10- :d. '+ 41
Date Paid:
Receipt Number:--' ';:JOL-ifo I
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7/~/"l L
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PI
Systems Development 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 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 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 witt 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. d the approved set of plans will remain
on the site a all imes duri'Vtruc~ I
Signature ~L-_
- "/
Date J, r /99'/
VALIDATION:
RECEIPT NUMBER 2G:>SB 7"~
DATE PAID '7/5/1/
AMOUNT RECEIV~" q 7'.: /3
RECEIVED BY