HomeMy WebLinkAboutPermit Mechanical 1999-6-2
~~ ,
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726.3759
ASSESSORS MAP:
LOT:
OWNER: '3'ok~ f>,,"~ltS~
ADDRESS: 's (. '3 :As ~n
CITY: 5.0 I C),
v
SPRINGFIELD
BLOCK:
STAT":', <9 L
JOB NUMBER ~c::::> .?y~
- , ~
225 Fi fth Street
Springfield, Oregon 97477
TAX LOT:, .:::><:::>.Jet::$<l:>
SUBDIVISION:
PHONE'
'72.t-6705
ZIP: 77477
DESCRIBE WORK: \Bel~c.e e')n'.s{~ 0;( b~lfr ~o...1G~6pi ((!'r c....vyj e/c<cfn'c.lV:<..<h1,,,-f.cfc/+r107os
NEW REMODEL ADDITION DEMOLISH OTHER
CONTRACTOR'S ~AME
GENERAL:
PLUMBING:
MECHANICAL: &~me..r rhr"".\.r\....
J
ELECTRICAl' B~",^ <: l?1.?rrf-
ADDRESS'
CONST,
CONTRACTOR #
EXPIRES/~ PHONE
,?Ga '(L.'v(]',,-' ~
, e>hfJ3
11-1 'f - 9'7 ,6f88\5ba<t
- OFFICE USE -
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: 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 made
after excavation, but prior to
seltlng forms,
D Underslab Plumbing/Electrical!
Mechanical ..... Prior to cover.
D Footing - After trenches 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 Plumblngl Mechanical
- Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking" .
~ .' I
D Floor Insulation - Prior to
decking. "
D Sanitary Sewer - Prior to filling
trench, '
D Storm Sewer - Prior to filling
trench. . ,.
O Water LIne -- PrlorJo filling
trench, ,',
"
, ,
REQUIRED INSPECTIONS
[X] Rough Mechanical - Prior to
X ~~64-5
D 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 - Prlo,~..~o cover.
D Wall/Ceiling Insulation - Prior to
cover.' " "
D Drywall- Prlor}o tapl,ng,
. . ,\ :.
D Wood Stovo - After Installation.
.. ;~.;..
,0 Insert - After fireplace approvlll
: ,., and Installation of unit.
o Curbcut & Approach - After
, forms are erected but prior to
placement .of concrete.
D Sidewall< & Driveway - After
excavation Is complete. forms
and'sub.base material In place.
o Fence- When cor,ipleted.
O ,Street Trees - When all required
trOGS ero planted. '
D Final Plumbing - When all
plumbing worl< Is complete.
, ,
D Final Electrical - When all
electrical work Is complete,
rn Final Mechanical - When all
mechanical work Is complete,
D Final Building - When all
required Inspections have been
approved and building Is
completed,
,.',~ Othe~ ,;:~
, ~.:; ~{//~t::;
'''~/
MOBILE HOME INSPECTIONS
o Blocking and ~et;Up - When all
blocking Is co'mplete,
o Plumbing Connections - When
home has been connected to
water and sewer.
D Electrical Connection - When
, blocking, set.up. and plumbing
Inspections have been approved
and the home Is connected to
th13 s~rv!gQ ~~!'\e',
D Final - After all required
, Inspections are approved and
porches, ~klrtlng, decks, and
venting haye been Installed,
('"
\
Leit faces
Lot Typ
,Lot sq,.Hg,:
Lot' coverage
Interior
Corner
Topography
..
Panhandle'
Total height
Cul.de'sac
BUIL[)ING' 'PE'R~IT
A. .t, ':'!~ .~:
ITEM
SQ, FT,
X $/SQ, FT,
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
'f:
:. ..... .:~
. ,1,:, 1 i:::1 ):,,;,\~: '
.,'l' '" '. 'I i l. S ~}\I'~i"~ ~,,'y,
.' ~ . - f..:,,~~,..:..'t)f.l/1~. .
.i '
,.,,'
':~4 .
,<
_J 'J'
~._J','
iI'~ .
. .
S THE PROPOSED WORK tN THE. ',...
HIST081CAL DI$TRICT, OR ON
THE HISTORiCAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
Setbacks ..
HSE I GAR ACe' I
p.L.
N
S
w
. -, .".",
E
VALUE
'.
SYSTEMS DEVELOPMENT CHARG,E (SDe)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary S!3wer
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/ Fireplace Unit
Dryer Vent
Mechanical Perml't
)VlI~
~~
"
. Issuance'
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
,
\
TOTAL AIV\OUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined) ,
FEE
/~~
- ~,
-/P,; '> ~
'r~
--2~. ..z~
{,,;'2
;' APPR.OVED:
BUILDING VALOE,JpLAN' 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 Number'
Received By:
Plans,Reviewed By
Date
Systems Deveiopment Charge Is due on all undeVeloped
properties within tho City limits which are being Improved,
ADDITIONAL COMMENTS
'. '~"'.. "
j,
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 Sprlngfi(~ld, 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
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.
Signature ~~
~ --7
Date
o::.~- ~ ~
./
VALIDATION:
RECEIPT NUMBER '3 0/ 2~C::-
6' ::;?--9'
DATE PAID
AMOUNT RECEIV~_D ~ J_"3 :<
RECEIVED BY n ~".'-J
" ~ / ,)-- - -
"
h~{'. ~~tFC?:
..'
'"",
, submitted has the following
The following prowct ~s equire 'specific land use
zoning, and does no r
approval.
Zoning.
225 FIFTH STREET Date _ ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 ' 0 Signature,
INSPECTION REQUEST: 7tw.!'ff6'9 City Job Number 99t1J:?l/"?
OFFICE: 726-3759- ,
3. COMPLETE FEE SCHEDULE BELOY
1. LOCATION)3~ INSTALLATION
~~~?~
LEGAL DESCRIPTION
/;~7~"3,:/"':::<~- e'~~
JOB DESCRIPTION ~ 1000 sq.ft. or less
ELt="c..T /l)~~ P~/(~ ""~7~Each addi tional. 500
, I' ,~) sq. ft or portIon
Permits are non-transferable and expire thereof
if work is not started within 180 days Each Manuf'd Home, or
of issuance or if work is suspended for Modular Dwelling
180 days. Service or Feeder
2. CONTRACTOR INSTALLATION ONLY
Electrical contractorB/nOS EleLtic
Addres~ In uJa.l1i <:,-#: t!. '
Cityt=::Ugfn-f Phonel~1j?iJd- '
Supervisor License Number 3041 ~
Expira tion Date J 0 - / -:J(y) I
Constr Contro Number -Z~rJ to;::)
Expiration Date Co - 0 - qq
signa~r?7of S~rv~g ~,~trician ,
~.f./)l~
Owners Name , hN,;t/ . ~~~
v .;lr' /,~~ ~r
Address 56-~ ~7)It:.-~
Ci tYh ~ ~ .Phone 7.7~ ~ AcJ ~
;' t' r, --I ," ."
OVNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
---------------------------------------
DATE:
RECEIPT #:
RECEIVED BY:
~ ,.2 ..cq~
-3 f../ 246
./ / .A""~" _ ..
r rvr-
A.
New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
Items
Sum
Cost
$ 85.00
$ 15.00
,$ 40.00
B.
Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C~
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps:"oT less $ 40.00
201 amps to 400 amps $ 55.00
Over 401 to 600 amps $ 80.00
Over 600 amps or 1000 volts see "B"
above
D.
Branch Circuits
,.
New, Alteration or Extension Per Panel
...,.---
One Circuit $ 35.00 :?~t>.e?
Each Addi tional ' -
Circuit or with Service
or Feeder Permi t 2. $ 2.00 7< ~
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res. $ 20.00
Limited Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE ~~, ~~
5% State Surcharge I . q!i'
3% Administrative Fee /. /~
TOTAL l7' 7 .. / 2.