HomeMy WebLinkAboutPermit Building 1991-4-12
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
,ASSESSo.RS MAP:
LOT:
...,
SPRINGFIELD
,-,?
JOB NUMBER
q\O \~~
BLOCK: -
225 Fifth Street
Springfield,Oregon97477
TAX ,LpT:.. ~ ~
SUBDIVISION:
OWNER: l\~L~ \ti\S\ bfllIJill\\
ADDRESS: +~ ,f.\3:l~ ..s~Q.oh f'
CITY: ,~)\(f{\~-rt) \J(\l, STATE: l\.)\\_~ C\fJ'() ZIP:-- C\l4"lS
:::RI8E wo::~o~~\ A Q:~'ON l\G~C::~L -lOOT~ 'i\(X)1'r\
CONTRACTO~AME .f". I'
GENERAL: ..L)\~ QJ~
p,LUMBIN~G:
MECHANICAL:
ELECTRICAL:
QUAD AREA: {3R~
# OF BLDGS:
occY GROUP: ?--~
# OF STORIES: I
WATER HEATER:
PHONE:
~~t.D rltft24
ADDRESS
CONST.
CONTRACTOR #
PHONE
REQUIRED INSPECTIONS
, t5<f~I17t4' ';f-;q,;j'eTUR.i!.-
. PRlP1'C To 'S7"Afi.-rIl"14' VVOf'fC:.
" D Site, Inspection - To be made. ''-~ Rough Electrical - Prior to
after excavation, but prior to ~"cover,
setting forms.
- OFFICE USE -
LAND USE:
\H\
# OF UNITS:
CONSTR, TYPE: ~f\J
HEAT SOURCE:
- RANGE:
EXPIRES
'. h
FLOOD PLAIN'
ZONING CODE: \s)R
# OF BDRMS:
,~
SECONDARY HEAT:
SQUARE FOOTAGE:
To request an inspection, you must call 726-3769, This is a 24 hour recording, All inspections requested before 7:00 a,n" will be
made the same working day, inspections requested after 7:00 a,m, will be made the following work day,
o
Underslab Plumbing I Electrical!
Mechanical - Prior to cover,
D Footing - After trenches are
excavated, ' '
D Masonry - $teel location, bond
beams, grouting, ,
D Foundation - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench,
D Underfloor' Plumbingl Mechanical
, - Prtor to insulation or decking,
, . .
D Post and Beam - Prior to floor
insulation or decking. .
D Floor Insulation - Prior to
decki ng,
D Sanitary Sewer - Prior to filling
trench,
D Storm Sewer - Prior to filling
trench,
D Water Line - Prior to filling
trench,
o Rough Plumbing - Prior to
cover,
D Rough Mechanical - Prior to
cover, . ,
D Electrical Service - Must be
approved to obtain permanent
electrical power,
D Fireplace - Prior to facing
materials and framing Insp,
ftFraming - Prior to cover,
, .'t521" Wall! Ceiling Insulation - Prior to
~cover,
)><1 DrywaU - Prior to taping, .
D Wood Stove - After installation,
D Insert - After. fireplace approval
and installation of unit.
D Curbcut & Approach - After
forms are erected but prior to
placement' of concrete. .
D Sidewalk & Driveway - After
excavation is complete, forms
,and sub~base material in place,
: /-
D Fence - When completed"
, D Street Trees : When- all' required .
trees are planted, ..' '
D
Final Plumbing - When all
plumbing work iS'complete,
. ~ Final Electrical~' When all,
~Iectric_al, work,is co~ple~e,..
D Final Mechanical - When all
mechanical work is complete,
,
1XI Final Building - When all
/' -fequired inspections have been
approved and building is
completed,
D Other
MOBILE HOME INSPECTIONS
D Blocking and Set-Up -, When all
blocking is complete,
D 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.
o Final - After all, required
_ .. inspections are approved and
porches, skirting, decks,and
venting have. been :installed,
Lot Type Setbacks
Interior I PL HSE GAR ACC I
IN I
Corner
Is
Panhandle
Iw
Cul-de-sac
IE
r
Lot faces
Lot sq, ftg,
Lot coverage
Topography
Total height
BUILDING PERMIT
ITEM SQ, FT, X $/SQ, FT,
VALUE
Main
Garage
Carport
t;o!..rY\ci)
l ()~. 'LL),
- ) ~:t;;o
.3./3
~ .5. ~3
SYSTEMS DEVELOPMENT CHARGE (SDC)
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s)
NO
Sanitary Sewer
FT.
Water
FT,
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Su rcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
105. &2:j
/
"
rHE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON n D
THE HISTORICAL REGISTER?V.\'
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 an)1 ~visions of said ordinances,
Plan Check Fee: '-tt). \..0 ~
Date Paid: \-3. \ . q J ~ .
Receipt Number:dC4f8-f83 \L13Bt
Receive B: C'1) \ ro _ )
~ff7U. _
Reviewed By
f -20- 'II
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 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,
Signatu~CJl.A. c;;L ~~
Date!:t~ rz- - q ,
VALIDATION: C 1 <,q
RECEIPT NUMBER ~ . , ~)
DATE PAID 4.:.. / Z .Lf J'
AMOUNT RECEIVFn~' "~(O::;. (n5
RECEIVED BY ( j ~ ..J
. "'t-"'"
- .J