HomeMy WebLinkAboutPermit Mechanical 1995-12-13
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
..
SPRINGFIELD
.
99'9"&3
JOB NUMBER
225 Fifth Street
Sprlngflela, Oregon 97477
LOCATION OF PROPOSED WORK' ~ ~/? ;.llA,V A/ %~ ,4,(/ LiP_
/ ~-'3" 3'-;/9"
OWNER' ~k~4 ;1?/..t:.7'L1,/i36?V
ADDRESS' ~ ~~/'Y"'~A
~P~.
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DESCRIBE WORK: Gs ~~-"'7 ~. A/C..IV Jt,:;,:..,.""!..~~ ,/:91:;.:;." ~- ,~ -~~:::a
ASSESSORS MAP:
LOT:
CITY'
NEW
REMODEL
BLOCK'
STATE:
~/:? '
ADDITION
DEMOLISH
OTHER
~'"?/'/ /
TAX LOT:
SUBDIVISION'
PHON~'
"?Y'?~:::>~~
ZIP'
""9?<9'""'''>~
ADDRESS
CONST.
CONTRACTOR'
EXPIRES, ',:, PHONE
CONTRACTOR'S NAME
GENERA' .
PLUMBING' .
/~_-/" g~""91 ''''~4''''~
MECHANICAL~--=---.J~ ~.... - "- .......~~~.:>S~ r'
ELECTRICA' '
~ //....~, ~q'S-- /~
r
;" ~.
- OFFICE U~E -
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 7Z6.3769, This Is a 24 hour recoralng, All Inspections requestea before 7:00 a,m, will be
made the same working day. Inspectlons 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.
'0 Underslab Plumbing/Electrical I
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o Masonry - Steel location, bond
.beams, grouting,
o Foundation - Alter forms Bre
erected but prior to concrete
placement.
o Underground Plumbing - Prior.
to filling trench.
o UnderfJoor Plumbing/Mechanical
- Prior to Insulation or aecklng,
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 Sower - Prior to tilling
trench.
o Water Line - Prior to filling
trench.
. 0 Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
IKJ Rough Mechanical - PrIor to
cover, ~I'?
o Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
o Framing - Prior to cover.
o Wall/Cellfng Insulation - Prior to
cover.
o Drywall - Prior to, taping,
o Wood Stovo - After Installation.
o Insert - After fireplace approvel
. and Installation 01 unit.
o Curbcut & Approach - After
'. forms are erected but prIor to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is compietc, 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 completo.
o Final Electrical - When all
electrical work Is complete.
lZI Final Mechanical - When all
mechanical wor1< Is complete.
C7#-5
o Final Building - When all
required Inspections have been
approved and building I.
completed.
[Z] Other.~ _ ~<::Lr
MOBILE HOME INSPECTIONS
o Blocking and Set.Up - When all
blocking Is complete.
o Plumbing Connoctlons - 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 ~ype .
Lot sq, fig.
Interior
Lot coverage
Corner
Topography
Total hel ght
Panhandle
Cul.de.sac
BUILDING PERMIT
ITEM SQ, FT, X $/ SQ, FT.
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
,.
. .) {,; .~ ~ . t..... : '.
('1 '.
_S TI;lE PROPOSED WORK iN THE.
"'HISTORICAL DISTRICT, OR ON
THE HtSTORICAL REGISTER?
It yes, this application must be slgnea
and approved by the Historical
Coordinator prior to permit issuance.
Setbacks
HSE GAR ACC
I PL.
IN
Is
Iw
IE
VALUE
"
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
tTEM
Fixtures
Residential Bath(s)
N'
Sanitary S~wer
Water
FT,
Storm Sewer
FT,
FT.,
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsert/Flreplace Unit
6i~t,~
r&7-
Mechanical Permit
~$
~~
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
fI
fI
Curbcut
Demolltlon
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
/~.~
/tP""'"
:f+
'26, -::2'
APPROVED'
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition thaI the said
construction shall, In all respects, conform to the Ordinance
adopted by the City of Sprlngflell!, Including the
Development Code, regulating the constructl<tn 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 all
Information hereon is true and correct, and I further cerllfy
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 Ihe 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 cara Is located at the front
of the property. and the approved set of plans will remain
on therzlte at r r~s d ring c.onstructlon.
Slgnatu .;A . I ---
/ .r'
Date /2-. "3 -~
VALIDATION:
RECEIPT NUMBER /qg<::) ~
DATE PAID '/'?'r- 9~
AMOUNT RECEIVEf1 y. '2&:>
RECEIVED BY 0~ .
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