HomeMy WebLinkAboutPermit Mechanical 1991-4-1
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RESIDENTIAL
PERMIT APPLICATION
SPRINGFIELD
"
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK: <if <21
I 7033 L!z..Z-
A-sp-e V\
1
AS,SESSORS MAP:
-LOT:
- BLOCK'- .
OWNER: '0 C{S-r, VI e..../l t' J
ADDR~~~' . 3'8 C; A=s p,~ ~
CITY: S'Pflof .
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STATE:
Of
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DESCRIBE WORK:
NEW
REMODEL
ADDITION 'x'
OTHER
DEMOLISH
JOB NUMBER
q [0 L2/
225 Fi fth Street
Springfield, Oregon' 97477
TAX LOT:
LJ6M
002..2:. 0
SUBDIVISION:
PHON E: 7 4 7 - 7757
ZIP:
q TLJ 7 7
/
CONTRACTOR'S NAME
ADDRESS
)
CONST.
CONTRACTOR #
PHONE
GENERAL:
PLlJt\t1_BING'
(~ lA) IA. .e V
I
1/
\if
MECHANICAL:
ELECTRICAL:
~~~ \\J - OFFICE USE -
QUAD AREA: LAND USE: \ \ \ \
-
# OF BLDGS' # OF UNITS:
OCCY GROUP' R~ CONSTR. TYPE: VN
# OF STORIES: I HEAT SOURCE:
WATER HEATER: RANGE:
EXPIRES
FLOOD PLAIN:
ZONING CODE:LD~~\jG ~
# OF BDRMS:
SECONDARY HEAT:
SQUARE pOOTAG E:
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,
REQUIRED INSPECTIONS
D Temporary Electric
1'-./( Rough Mechanical - Prior to
JC:S.cover. .:DRye;(
- / ~
1.><1 Site Inspection -:- To be made _ " Rough Electrical - Prior to
~ after excavation, but prior to over.
setting forms. Sl-A" & tSsAIC. ~.
D Un,derslab Plumbing/Electrical/
Mechanical - Prior to cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
lxf Footing"":" After trenches are
~xcavated. IFR€Qb; ey 1",~~Ee7iX
D Fireplace - Prior to facing
'materials and fra,ming Insp.
D Masonry - $teel location, bond
beams, grouting. _
~Framing - Prior to cover.
D Foundation - After forms are
erected but prior to concrete
placement.
r--.t"f Wall/Ceiling Insulation - Prior to
~over.
D Underground Plumbing - Prior
to filling trench.
1'-../"( Underfloo('PlumbinQy Mechanical
~- Prior t~ula.~;~ or decking.
.J><L?rywall - Prior to taping.
..... .
. D Wood Stove - After installation.
'1><.i Post and Beall1 - Prior to. floW
.T ~sulation or decking. ..
D Insert......; After fireplace approval
and installation of unit.
. ~( Floor Insulation - Prior to
)L.::i. decki ng.
D Curbcut & Approach - After
forms are erected but prior to
placement' of concrete.
D Sanitary Sewer - Prior to filling
trench,
D Stor'!' Sewer - Prior to filling
trench.
D.Sidewalk & Driveway - After
excavation is complete, forms
. and sub-base material in place.
o Water Line - Prior to filling
trench. .
D Fence - 'Whe~ completed.
!:><rROU9h Plumbing - Prior to
,,{(over. .
o StreetTr~es -Whe',,'aW"requ,ired
trees are plan~ed.
~ Final Plumbing ~ Whe~' all'
~Iumbing work is complete.
~. Final" Electrical. -'- When all
~electrical. work i~ complete.
1><1 Final Mechanical - When all
" ,."echanical work is complete.
l'~'''' Final Building - When all
~required inspections have been
approved and building is -
completed.
D Other
MOBILE HOME INSPECTIONS
D Blocking and Set-Up - When all
blocking is complete.
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
the service panel.
D Final - After all required
- inspections are approved and
. porches, ski rting, decks, arid'
" . v!3nting have been'installe.d.
lot faces
--W-
lot Type
lot sq. ftg.
Interior
lot coverage
Corner
Topography
Total height
Panhandle
Cul-de-sac
BUILDING PERMIT
ITEM SO. FT.
X $/SO. FT.
Main
Garage
~1J'5
/~/O
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
,'.
Setbacks
I
P.L. HSE GAR ACC
N
S
W
IE
VALUE
~f), '2,1!
J2..57~
l13 0 (j
,
.&)/),5"0
2,53
S .3,1> 3'
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) II/A_
PLUMBIN'G PERMIT
ITEM
Fixtures
----ZV/o
Residential Bath(s)
NO
Sanitary Sewer
FT.
Water
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Fu mace
Exhaust Hood
Vent Fan
NO
Wood Stove/lnsert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Su rcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
2DO~
2-1'/ t>P
100
2-/.00
/viI,(/',
/500
I () 00
/2-5
Zt::..2- S;
jt2fJ ,2.5
/~""3' '
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
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.
32- . ~ 3
Date Paid: ?r'--l _ell
Receipt Number' ft131.ro
Re~@~
Pla~ Ftevlewed By -
Plan Check Fee:
5-27-91
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 pertai ni ng to the work descri bed
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 AA.I g;;iAJI
Lf-I-9/
Date
VALIDATION:
RECEIPT NUMBER /96/6
DATE PAID C(-/' ? /
AMOUNT RECEIVE~./ /C'c>_ ?8
REC~IVED BY ~~~~~
.~~
Permit No:
Address:
Issued by:
Date:
FOR o.FFICE USE ONLY
, STATEM ENT:
. INFORMATION NOTICE TO PROPERTY OWNERS
'ABOUrCONSTRUCTION RESPONSIBILITIES
Note: .Oregon Law; ORS701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
following statement before the building permit can be' issued. Licensed Architect
. and Engineer applicants, exempt from registration 'under ORS 701.010(7), need
not submit this .statement. This statement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 2B:
.....
,
1. I' \( I I own, reside in, or will reside in the completed structure.
,,'
,2. A. I. I' .' My genera," contractor is
. Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B. I I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board. If I change my mind and 00 hire a general
contractor, I will contract with a contractor who is registered With the
Construction Contractors Board and I will immediately notify the office
issuing this building permit of the name of the contractor.
I hereby certify that the above information is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
4h) (Jy~)l
Signature' of Permit Applicant
Jj-I-'1/
Date '
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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