HomeMy WebLinkAboutPermit Building 1999-3-15
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726,3759
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SPRI..._.-.,.:o...D
LOCATION OF PROPOSED WORK' I~t !)
176'$l-7~l-
ASSESSORS MAP'
LOT:
n . ft1k1
ADDRESS' /')fo W
CITY:-5f~
f) Ib1 14,/
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OWNER:
,
DESCRIBE WORK'
NEW
REMODEL
CONTRACTOR'S NAME
GENERAL' I'J tAl IV p .,
PLUMBING'
MECHANICAl'
ELECTRICAL'
BLOCK:
e
Lk. ../Zv,.f'
({u;'fI'd r
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JOB NUMBER J!lIJ J 1./'2--
225 Fifth Street
Springfield, Oregon 97477
TAX LOT'
SU8DIVISION'
(JOII'?
STATE:
01"/
PHON~'
ZIP:
'17'1'?7
~alJt.
/1111 Nl/JL
/1/11"",,6,':-
I /
OTHER
ADDRESS
CONST.
CONTRACTOR'
EXPIRES .-:- PHONE
~QUIRED INSPECTIONS
ough Mechanical - Prior to
cover.
o Rough Electrical - Prior to
CQver.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
ramlng - Prior to cover.
ail/Ceiling Insulation - Prior to
cover.
Drywafl - Prior to taping.
o Wood Stovo - After Installation.
o Insert - After fireplace approvl!S1
and Installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Sldewafl, & Driveway - After
excavation Is complete. forms
and sub-base material In place.
o Fence - 'Nhen cOinpleted.
o Street Trees - When all required
trees are planted.
. OF BDRMS'
SECONIJARY HEAT:
SQUARE FOOTAGE:
To request an Inspection, you must catl 726,3769, This Is a 24 hour recording, Alllnspecllons 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.
ADDITION
DEMOLISH
-'''~ ~~~v~~ ~NAll EXPIRE IFTHE WORK
'". ''-u UIVlJt:r< THIS PJ:J:lUIT 1<' ~::r
- OFFICE USE ...:. ~Ar\DONED FOR
ATTENTION:Oregon law hJ4~lIeb y", L.. ANY 180 DAY PERIOD
QUAD AREA: -!QH:".: ::.:~:: ::':;3ted by th!;~@g\l~IU::!:::,' FLOOD PLAIN'
. OF BLDGS' Notification Center. Those rj,l'OFlV'f'liiStforth ZONING CODE:_
In UAH 952'001-0010 through OAR 952-001-
OCCY GROUP: ~~t'~, '(6:': c~a~in copi&OSl~J1iB'ri'j~c-.:.,-
. OF STORIES' calling the center. (Note:,ttI?A!f.l~UReE:
numoer lor the Oregon Utility Notitication
WATER HEATER: ':':~::: ': 1 800-33:..~()I.\>1j:-
o Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumblng/Electrlcall
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
~enCh'
ough Plumbing - Prior to
cover.
~'!~;:~E.
~Inal Plumbing - When all
~PIUmblng w9rl~ Is complete.
D Final Elcctrlcnl - When all
electrical work Is complete.
D Jnal Mechanical - When all
~echanlcal work Is complete.
~FI al Building - When all
r qui red Inspections have been
pproved and building Is
completed.
o Other
MOBILE HOME INSPECTIONS
o Blocking and Set-Up - When all
blocking Is complete.
o 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 sq, ftg,
Lot coverage
Topography
Total height
Setbacks
I P.L. HSE GAR ACC
IN
Is
Lot Type.
InterIor
Corner
Panhandle "
Cul.de'sac
_VlJ._ _
IE
BUILDING PERMIT " .~
ITEM sa. FT. x $/SO. FT. VALUE
Main
"
Garage
Carport
\
Total Value
Building Permit Fee 1<:, ~Q
State Surcharge tff" /J f
Total Fee (A) _11. l-<)
SYSTEMS DEVELOPMENT CHARGE (SDC)
, , (B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
Sanitary S~wer
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
>
FEE
30
N'
FE
FT.
FT.
(C)
30,(}/J
'l....-<{O
3 Z. 'fi)
Wood StovellnsertlFlreplace Unit
N'
Drxer Vent
1'-.+-1" /HW.,..
~
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
))""elJ
/6.- Of)
l./("17J
2.tl..4
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
T1 <('()
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
,
. , ,';- ~ ! .:'~
'-i:; "
~
ieTHE PROPOSED WORK iN THE, ·
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
II yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance,
1_._-
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 01 Sprlngfteld, including the
Development Code, regulating the construction and use of
ouildings, 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
Note:
Building Inspector may require
additional plans information,
and/or fecs for the completion of
this project.
By signature, I state and agree, that I have carefUlly examined
the completed applicatlon and do hereby certlfy 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 pertaining to tho 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 'n 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.
Signatur~-BO C/'
Date '3.~
VALIDATION:
03 )Ilk
RECEIPT NUMBER
DATE PAl" "3/ IS-I 1 r
AMOUNT RECEIVED --;t!- fV.
RECEIVED BY /;,t! vJ ~