HomeMy WebLinkAboutPermit Plumbing 1991-5-23
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;RESIDENTlAL'
PERMIT APPLICATION
Inspections: 7~6~3769
Office: 726.3759
ASSE~SO.RS MAP:
LOT:
OWNER:
ADDRESS:
CITY:
DESCRIBE WORK:
NEW
CONTRACTOR'S NAME
GENER.AI'
.PLlJMBING:.
MECHANICAl'
ELECTRICAL:
()\AM~
SPRINGFIELD
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BLOCK:
STATE:
a-R
JOB NUMBER
ql()I~3
-1-A i + J?./f
,225 Fifth Street
Springfield, Oregon 97477
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TAX LOT:
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SUBDIVISION:
PHONE:
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ZIP:
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, DEMOLISH
OTHER
ADDRESS
CONST.
CONTRACTOR #
. PHONE
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cove~ .
D Rough Electrical - Prior to
cover.
D Electrical Service - Must be
approved, to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp,
D Framing - Prior to cover.
D Wall/Ceiling hisulation - Prior to
cover, '
D Drywall - 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,
o Fence - When completed,
D Street Trees - When"all'required "
trees are planted.
EXPIRES
I
- 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: 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 maae the following work day,
lliFinal Plumbing - When all
plumbing work is complete,
D' Final Electrical - When all
electrical work is complete,
D
Final Mechanical - When all
mechanical work is complete,
D Temporary Electric
o Sit,e Inspection - To be made
after excavation, but prior to
setting 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 fo'rms are
.. erected but prior to concrete
placement:
D Underground Plumbing - Prior
to filling trench.
D 'Underfloor Plumbing/Mechanical
- Prior to insulation or decking,
D Post and Beam - Prior t'o 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.
~ Rough Plumbing - Prior to
cover,
D Final Building - When al'l
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,
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
,. '.. i ns.pect~6ns 'are approved and'
" porches, skirting, decks, and' .
venting have. been installed,
Total height
.,,~
lot Type Setbacks HE PROPOSED WORK IN THE
Interior I P.L HSE GAR Accl HISTORICAL DISTRICT; OR ON
IN I THE HISTORICAL REGISTER?
Corner Is I If yes, this application must be signed
Panhandle and approved by the Historical
Iw I Coordinator prior to permit issuance,
Cul-de-sac
IE I APPROVED:
lot faces
lot sq, ftg, '
lot coverage
Topography
ITEM
SQ, FT
X $/SQ, FT
VALUE
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
BUILDING PERMIT
Main
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,
Garage
Carport
Plan Check Fee:
Date Paid:
Total Value
Receipt Number'
Building Permit Fee
Received By:
State Su rcharge
Total Fee
(A)
Plans Reviewed By
Date '
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved,
PLUMBING PERMIT
ITEM
Fi xtu res :2 (J /OOU
Residential Bath(s) NO
Sanitary Sewer FT
Water FT
Storm Sewer FT
Mobile Home
ADDITIONAL COMMENTS
FEE
~;n ,00
Total Charge
(C)
~.()O
/.00
;:l \ 00
Plumbing Permit
State Surcharge
MECHANICAL PERMIT
Fu rnace
Vent Fan
NO
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,
Exhaust Hood
Wood Stove/lnsert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
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 a~1 t7s dUr~ng construction,______..
Signature~ ~...-
....
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Date
~-:J.~-C) )
Curbcut
ft
Demolition
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
~-'
~\hD-
RECEIPT NUMBER
DATE PAID "5):::l.<.,,)p., J
AMOUNT RECEIVED S'.:::l / ()I',
onl17
State Surcharge
VALIDATION:
,
Total Miscellaneous Permits (E)
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RECEIVED BY
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Permit No:
o iOJ93
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Address:
'.Issued by:
Q~
Date:, S/';:)=<.,)q I
FOR'OFFICE USE ONLY'
. ST A TEM ENT:
, . INFORMATION NOTICE;TO' PROPERTY OWNERS
ABOUT CONSTRUCTION'REsPONsIBILJTIES
'Note: Oregon Law, ORS701.055(4), requires residential building permit applicants
who are not reg.istered 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 2kor 2B:
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1..1../1 I own, reside injor will reside in the completed structure.
--
2. A. I My genera,1 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 y( 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 Qeneral
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.
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'Signature of Perm.it Applicant -
c;-.).~~s I
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
'VI" (
WHITE COPY TO ISSUING AGENCY PERMIT FILE
Vi'^'\ ~~ COPY TO APPLICANT
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