HomeMy WebLinkAboutPermit Mechanical 1996-8-1
RESIDENTIAL
PERMIT APPLICATION
, Inspections: 726-3769
Office: 726.3759
LOCATION OF PROPOSED WORK: LI Lit 7c;5'
17 O-Z--z; 2 '?, I
.
UlRL! G~ !luck
ADDRESS: 44"1 ~ kkr- '
s.p.;u Vlg+leJd
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REMODEL V ADDITION
ASSESSORS MAP:
LOT:
OWNER:
CITY:
DESCRIBE WORK:
NEW
ELECTRICAL:
BLOCK:
STATE:
DR.
JOB NUMBER
q 0Jf)L/!L
DEMOLISH
OTHER
225 Fifth Street
Springfield, Oregon 97477
TAX LOT:
SUBDiVisION:
O&;ZtJ()
PHONE:
7L/b-SiPi3
ZIP:~
ADDRESS
CONST.
CONTRACTOR It
PHONE
REQUIRED INSPECTIONS
D
Rough Mechanical - Prior to
cover,
CONTRACTOR'S NAME
GENERAL:
PLUMBING: '
MECHANICAL: eomto(+~OW Uea..-hVlC) PSI DonS. Sp~d OD4Io6
EXPIRES
10- 21---9 7
'7llh- () /00
- OFFICE USE -
QUAD AREA: LAND USE:_, FLOOD rLAIN:
It OF BLDGS: It OF UNITS: ZONING CODE:
OCCY GROUP: CONSTR. TYPE: ___ It OF BDRMS:
It OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGE: 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
o
Site Inspection - To be made
a(ter excavation, but prior to
setting (orms,
o Underslab Plumbing/ Electrical/
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.
D
Underground Plumbing - Prior
to filling trench.
o
Undertloor Plumbing/Mechanical
- Prior to Insulation or decl~lng,
o
Post and Beam - Prior to floor
Insulation or decking,
D Floor Insulation - Prior to.
decking, _
O Sanitary Sewer - Prior to filling
trench. ',I
o Storm Sewer - Prior to filling
trench, . '
o
Water LIne - Prl'or to filling
trench.
o
Rough Plumbing - Prior to
cover.
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 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 & Approilch - 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 - Wt1en completed,
o
Street Trees - When all required
trees are planted.
o
Final Plumbing - When all
plumbing worl< Is complete.
o Final Electrlcnl - When all
electrical work is complete,
~ Mechnnlcal - When all
mechanical worl~ Is complete,
o Flnnl Building - When all
required Inspections have been
approved 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 tile home is connected to
t he service panel.
o
Final - After all required
Inspections are approved and
porches, skirting, decl~s, and
venting have been Installed,
Lot faces
Lot Type
Lot sq,ftg.
Interior
Lot coverage
Corner
Topography
Total height
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)
. Setbacks
P',L, HSE GAR ACC I
N
S
.\w
IE
VA LU E
"
-~" ,
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
NO
Sanitary S~wer
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/lnserllFlreplace Unit
qryer Vent
lflU{J~IA MVO
Mechanical Permit
sub
Issuance
State Surcharge d.. Uty ~1A-
Total Permit (D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharg~
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
FEE
It;,oO
/5.0-0
ID-ao
-L-l ()_
;2{o.2J)
S 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
adopied 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 ordlnan'ces.
Plan Check Fee:
Date Paid:
Receipt Number'
Received By:
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties within tile 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 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 er time, that each address Is readable
from the stree , that the permit card Is located at the front
of the prope~ y, an t e approved set of plans will remain
:~g~::":~e t ~if,"g C~;]] 0 ~
Dat< f yo a
VALIDATION:
RECEIPT NUMBER )} '?-2S-
~-/~q~
AMOUNT RECEIVED 2& .. W
W/
DATE PAID
RECEIVED BY