HomeMy WebLinkAboutPermit Mechanical 5-10-3
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
'Office: 726-3759
ASSESSORS MAP:
LOT:
,OWNER:
ADDRESS:
CITY'
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DESCRIBE WORK:
NEW
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERAL:
PLUMBING:
SPRINGFIELD
A-t/8
BLOCK'
STATE:
IJ~
~~~~
/ '~EMOLlSH
JOB NUMBER
95"/56&
225 Fifth Street
Springfield, Oregon 97477
TAX LOT:
r0 <~ )i:2-) 0 n
SUBDIVISION:
PHONE:
ZIP:
C[7 $I? 7
~/ d"y ~dj1th...,.~~J~rr
,
OTHER
ADDRESS'"
CONST.
..... CONTRACTOR 1/
EXPIRES", PHONE
MECHANICAL:
ELECTRICAL:
!tU/b7 ~d~tI
~,
~
,~ 57?J5lJ5 U'c 75 3l/q.,.d)'1~1
/
- OFFICE USE -
QUAD AREA: LI>.ND USE: FLOOD PLAIN'
1/ OF BLDGS: 1/ OF UNITS: ZONING CODE:
OCCY GROUP: CONSTR, TYPE: 1/ OF BDRMS:
1/ OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGE: __ SQUARE FOOTAGE:
To request an Inspection, you must call 726-3769, This Is 324 hour recording. All Inspections requested before 7:00 3,m, will be
made the same working day, Inspections requested after 7:00 a,m. will be made the following work day,
REQUIRED INSPECTIONS
rs?i'RoU9h Mechanical - Prl~r to
/ v '\ cover.
o Temporary Electric
o Site Inspf3ction - To be made
, after excavation, but prior to
setting forms.
o
Underslab Plumbing/Electrical/
Mechanical - Prior to cover,
o
Footing - After trenches are
excavated,
o
Masonry - 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 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,
0' Rough Plumbing - Prior to
cover,.. '
'f::;ti Rough Electrical - Prior to
~cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
o Framing - Prior to cov~r:,.
o Wall/Ceiling Insulation - Prior to
cover. '
D Drywall - Prior to, taping:
o Wood Stovo - After Installation.
o Insert - After fireplace approval
. and Installation of unit.
o Curbcut & Approach - After
. forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
, excavation Is'complete, forms
and sub-base material In place:
o Fence - When completed,
o Street Trees - When all required
trees are planted,
o Final Plumbing - When all
plumbing work Is complete,
"K:7(flnal Electrical - When all
)6{ electrical work is complete,
i'-c7( Final Mechanical - When all
....~mechanlcal work Is complete,
o Final Building - When all
required Inspections have been
approved and building is
completed.
tx1 Other 6;';1(' !.//.u6
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MOBILE HOME INSPECTIONS
o Blocking and Set-Up - When all
blocking Is complete,
,0 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
porches, skirting, decks, and
venting have been Installed,
Lot faces
'Lot TYJ:
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
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
I P,L.
IN
/S
Iw
IE
VALUE
"
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
NO
Sanitary Sewer
FT. '
Water
FT,
FT.
Storm Sewer
Mobile Home
FEE
Plumbing Permit
,/
~.---
,,/
./
-_..~--------~.~----..-
-~.--
-~
'"
"
State Surcharge //
/
Total Charge // (C)
MEC~H,,~,iCAL PERMIT
Furnace
Exhaus Hood
Vent Fin NO
Wood ftove/lnsert/FlrePlace Unit
Dryer ~e~t
U~ L/"ut<:;
MeChan~~al Permit ' ~/O,
Issuance
/ State surc/~,~__: I 1..)" -I- J -I- s-
Total ~ermil (D)
MISCELJANEd'U.S PERMITS
/
/
"
'?
/
/
Mobile Home----.,'-________
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTALAMOUNT DUE (excluding eleCVIj;;al)
(A, B, C, 0, and E Combined)
J JL ,6--tJ)
/?f//t )
2q--o
, C'" 00
);, J,
/D,.60
. /.20
~?- ~O/'
,
_/
~/ 20
~4,
Setbacks
IHSE GAR
I
I
I
I
IS THE PROPOSED WORK IN THE,
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be slgnyd
and approved by the Historical
Coordinator prior to permit issuance,
ACC I
I
I
I
I
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:
Date Paid:
Receipt Numbcr:__,_,__
Received By:
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties within tho City limits which are being improved.
ADDITIONAL COMMENTS
"
",
/
/
\
By ina,:: I "atc and ag 'ee, 'ha' I have c",clully .,amlned
the cFmPleted application and do hereby certify that all
Inforratlon hereon is true and correct, and I further certify
that any and all work performed shall be done in accordance
with the Ordinanctls of the City of Springfield, and the Laws
of teState of Oregon pertaining to the work described
he~ In, and that NO OCCUPANCY will be made of any
st cture without permission of the Build/rig Safety Division,
I urther certify that only contractors and employees who
/ re 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 all times during construction,
Slgna'"e ~ f!L$ndL
/1) --nA-q,')
Date
VALIDATION:,
RECEIPT NUMBER
/9/&?,
/D/3/)J-
~~. 20
.--4. { ....-?..,.
~~
DATE PAID
AMOUNT RECEIVED
RECEIVED BY