HomeMy WebLinkAboutPermit Building 1997-1-27
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Offjc~: 726.3759
SPRINGFIELD -...
/-'
JOB NUMBER 9~~8-3 0/
225 Fifth Street
Springfield, Oregon 97477
LOCATION OF PROPOS~D WORK: ~~ ,~:2?~;PQE ?~~
ASSESSORS MAP: /4fZ 't?2-d6~/:2 _ TAX LOT: c::? '::2...~~
LOT: I?~ . 'BL~K: SUBDIVISION:h.Yt'JF:~C;~5
OWNER: ./!f(,~~A/ ~~~~~~r~ ~ .
ADDRESS: ~Z SG~ :9-3~pw~.2:>_./~
. ~~~?;>_ -- r-.rSTATE:-' ~.
.r.r / - -, /
DESCRIBE WORK: ~7/CF. ~7",~c... #~fi.c-
CITY:
NEW
REMODEL
ADDITION
DEMOLISH
OTHER
PHONE:
7,V~-6~
~
, r
/;:>~g
64/~~--
ZIP:
CONST.
CONTRACTOR /I
CONTRACTOR'S NAME ADDRESS
GENERAl' ~~F"~ :Z":A/7'_
t~1 ;"- f~- ~--.~
PLUMBING:
MECHANICAL:
ELECTRICAL:
EXPIRES " PHONE
- OFFICE USE -
QUAD AREA: LAND USE: FLOOD PLAIN:
/I OF BLDGS: ' /I OF UNITS: ZONING CODE:
OCCY GROUP: CONSTR, TYPE: /I OF BDRMS:
/I OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGE: SQUARE FOOTAGE:
To request an Inspection, you must call 726-3769. Tills 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.
D Temporary Electric
D
Site Inspection - To be made
after excavation, but prior to
setting forms.
D
Underslab Plumbing/ Electrical!
Mechanical - Prior to cover.
o
Footing - After trenches are
excavate,d. _
o Masonry - Steel location, bond
beams, grouting.
,
ot
o
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.
o
Post and Beam - Prior to floor
Insulation or decking,
o Floor Insulation - Prior to
decking..
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench.
o Water Line - Prior to filling
trench. , '.
o Rough Plumbing - Prior to
cove~ .
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover. .
~
Rough Electrical - Prior to
cove~ \
o
Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
[E] Framing - Prior to cover.
o Wall/Ceiling Insulation - Prior to
cover.
o Drywall - P~lor to taping.
o 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.
en
I
Sidewalk & Driveway - After
excavation Is complete, forms
and sul)-ba~e material in place.
o Fence - When completed.
.D Street Trees - When all rqquired
.. trees are planted. '.
D
Final Plumbing - When all
plumbing wor\< is complete.
C!l
Final Electrical - When all
electrical worl< is complete.
D
Final Mechanical - When all
mechanical work Is complete.
o
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
blockln~J is complete.
o 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. r
o Final - After all required .
inspections are approved and
porches, s\<irting, decks, and
venting have been installed.
#/4, -I-/!? ~
7~ :~
, .
-/6~ 2t?
SYSTEMS DEVELOPMENT CHARGE (SDC)
Lot faces
Lot Type:.
Lot sq. ftg.
Interior
Lot coverage
Corner
Topography
Panhandle
Total height
Cul.de-sac
BUILDING PERMIT
ITEM
SQ. FT.
X $/SQ. FT.
Main
Garage
Carport
M. ~~~C,
f/),- /' -'~~'~""
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
NO
Sanitary S~wer
Water
FT.
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Horne
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permi ts (E)
Setbacks
I P.L. I HSE GAR
I N I
I s' I
I
W
---L_,
VALUE
"
~~ -e>
FEE
TOTAL AMOUNT DUE (excluding electrical) ~ ~?~
(A, 8, C, 0, and E Combined)
.' . ~ ":.'~~'
,: '.
_i' .
-'
ACC I
I
I
I
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IS THE PROPOSED WORK 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.
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
'. construciion 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:
<J.?~
. "
Date Paid:
Receipt Number:
Received By:
Plans Reviewed By
Date
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 wi thout 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 10 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 times durin constr~
~' .
Signature .~,~ 0 _
~.
~
Date !\ -. -z. I -C(
)
/
VALIDATION:
RECEIPT NUMBER ? 7/~2o
I -'2~'/ ?
AMOUNT RECEIVED, ':2 7' ~ e:@ "::>
~4 .
~,.,...:r ~
"
, /
DATE PAID
RECEIVED BY
00CIIIt ~ 0
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