HomeMy WebLinkAboutPermit Mechanical 1995-5-2
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
SPRINGFIELD
LOCATION OF PROPOSED WORK' f)r;?(
I Y) 0 ~ ~ ~ 017
ASSESSORS MAP:
LOT:
BLOCK:
JOB NUMBER Cf!JtfJ67tj
225 Fifth Street
Springfield, Oregon 97477
TAX LOT:
(J1j{J{)
SUBDIVISION:
OWN EA' --'1,(J1! d UJae.t::hY PHON E' 'I tJ& - UJ' tI'(L?
ADDRESS:' ,fA 1t7 !JJh~ MfJ/LUJu ,-
CITY: JA~Jj Ii STATE:' [If'L ZIP: Cf1lf.17
/ /7)'
DESCAIBE WOAK tJiJ/lflVZ/ / ;-tffJP.. f1Jdt(iiflb.ila; ,. ~.1jtoY;
NEW REMODEL ADDITION [1'- , DEMOLISH OTHER
CONTRACTOR'S NAME
GENERAL:
PLUMBING:
MECHANICAL:
ELECTRICAL:
f)i(UH.hr~
ADDRESS
CONST,
CONTRACTOR It
PHONE
~Liof[d;- ,
EXPIRES
(dllcj0-s-'
j0&r0rU-kL
- OFFICE USE -
QUAD AREA: LAND USE: FLOOD PLAIN'
It OF BLDGS: It OF UNITS: ZONING CODE:
OCCY GROUP: CONSTR. TYPE: It OF BDRMS:
It OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGF: 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,
D Temporary Electric
D Site Inspection - To, be mado
after excavation, but prior to
setting forms.
D Underslab Plumbing/ Electrical~
Mechanical - Prior to cover,
D Footing - After trer;ches are
excavated.
D Masonry - Steel location, bond
beams, grouting.
D Foundation - After forms are
erected' but, prior to concrete
placement,
D Underground Plumbing - Prior
to filling trench,
D Underlloor Plumbing/Mechanical
- PrJor t~: Jnsulatlon or decking.
D Post and Bea'm - Prior to floor
Insulation or decking,
D Floor Insulation..... Prior to
decking.
D Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior to filling
trench,
D Water line - Prior to filling
trench, .
D Rough Plumbing - Prior to
cover,
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
, 0 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.
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 Stre..et Tree~.,':-' When alt req01red
trees are planted~.<;,. '.
hi' Final Plumbing - When all
~Iumblng w()rl< Is complete.
o Final Electrical...;.. When all
, electrical work Is complete.
~Inal Mechanical - When all
)6l ~ech'anicaJ work Is complete.
o Final Building - When all
required Inspections have been
approved and building Is
completed.
~. Other C~ I/A'J-c'
MOBILE HOME INSPECTIONS
o Blocking ,and Set.Up - When all
blocking Is complete.
o PJumblng Connections - When
home has been connected to
water and sewer,
o
Electrical Connection - When
blockiQg,set.up, and plumbing
Inspections have been approved
and the home is connected to
the service panel.
o Final - After all required
' I nS'pections are approved and
' porches, skirting, decks, and
venting have been installed,
Lot faces ,
Lot Ty;!
Lot'sq, ftg.
Interior
Lot coverage
Topography
Total height
Corner
Panhandle
Cul-de,sac '
BUILDING PERMIT
ITEM
SQ. FT.
X $/SQ, FT.
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
"..;-"
. , : :;:~""~{d~~ :, '
Setbacks .
I P.L. 'HSE' GAR ACe I
IN
Is
Iw
IE
VALUE
"
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
/
Residential Bath(s) NO
Sanitary Sewer FT.
Water FT.
Storm Sewer FT,
Mobile Home
Plumbing Permit
State Surcharge
( 7r -f-(~ J
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
4A-\ //#//\ : o//Y
Mechanical Permit
Issuance
State Surcharge
, 7 J- -r ( f )~
Total Permit
.(D)
MISCELLt~NEOUS PERMITS
Mobile ,Home
'State Issuance
State Surcharge
Sidewalk
ft
ft
Curbcut
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
/?? ,;' A.J
/.<:"&K)
I 2..D
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- r
~/,J
J 6 GH.;>
) D,Ck>
/.20
,?/~ 2..0
., '. IS THE PROPOSED WORK tN 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 expre'SS 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 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 ail
Information hereon Is true and correct, and I further certify
that any and all work performed shall be done In accordance
with the Ordlnanc~s 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
projec,t.
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 Iheapproved set of plans will remain
o,n. the site at a~~structlon.
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Slg'nature __'____
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Date'''". ~~' ,
, .//
VALIDATION: ;
RECEIPT NUMBER 0 /i]j}, I
DATE PAID !i/~ jqt5' I
M.1'OUNT RECEIVEotf . IJ;:J. 'L/()
RECEIVED BY 1'0 W1tI'