HomeMy WebLinkAboutPermit Building 1991-11-15
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK'
ASSESSORS MAP'
LOT:
#:tc."
OWNER'
ADDRESf"
CITY'
DESCRIBE WORK'
NEW
7<
REMODEL
.
BLOCK'
STAT'"
ADDITION
DEMOLISH
OTHER
.
q 11-;;). J5i>
JOB NUMBER
225 Fifth Street
Springfield. Oregon 97477
TAX LOT'
SUBDIVIS';ONI{g,..,i,,,'-<J
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PHONF'
SLcf,,'Y7 (,.,
ZIP:
CON ST.
CONTRACTOR'
CONTRACTOR'S NAME ADDRESS
GENERAl' /..:1;;.-, d? /,1" ... ~ 9f-.L 'YkQp_tl..., ~
PLUMBING: G.,.t.r.....~ ~"11- K~ .~
, I . (\'
MECHANICAL: t[?,,(~... JoLo. <':;70 1- JVH: ".
ELECTRICAL: I~J""".I i:~;t.; LV" ~ 11 V ~. t IW
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EXPIRES PHONE
(,{~1 ~ r';l) &,
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(' (- _ -" 7 =- .! :;-
\ ~.J\)~ t) - OFFICE USE -
QUAD AREA: LAND USE: \\ \ \ FLOOD PLAIN:. U
. OF BLDGS: - \ . OF UNITS' \ J ZONING CODE: ~ I
OCCY GROUP: ~-)\ W\ CONSTR. TYPE:~l _ . OF BDRMS: '. .
. OF STORIES: . I . HEAT SOUR"E' ~q SECONDARY HEAT' t:V
WATER HEATER' .~ RANGE' F:' SQUARE FOOTAGE: V&~
.~.
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.
o Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
settIng forms.
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
~ Footing - After trenches are
excavated.
D
Masonry - Steel location, bond
beams, grouting.
IZl Foundation - After forms are
erected but prior to concrete
placement.
[2] Underground Plumbing - Prior
to filling trench.
eEl
Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
[2g
Post and Beam - Prior to f10qr
Insulation or decking.
[Xl Floor Insulation - Prior to
decking.
[6l Sanitary Sewer - Prior to filling
trench.
[Xl Storm Sewer - Prior to filling
trench.
[X] Wa~er Line - Prior to filling
~~n'h., .
l">r'i=l';.Ugh Plumbing - Prior to
L,LJ cover.
.~. .
REQUIRED INSPECTIONS
I7l Rough Mechanical - Prior to
~ cover.
~ Rough Electrical - Prior to
cover. .
r:1I Electrical Service - Must be
~ approved to obtain permanent
electrical power.
rn Fireplace - Prior to facing
materials and framing Insp.
C1l Framing - Prior to cover.
~ Wall/Ceiling Insulation - Prior to
cover.
C4I Drywall - Prior to taping.
o Wood Stove - After Installation.
D Insert - After fireplace approval
and Installation of unit.
[ll Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
CXI Sidewalk & Driveway - After
excavation is complete, forms
and sub.base materIal in place.
C2!I Fence - When completed.
o Street Trees - When' all required'
trees are p~anted.
[LrJ
Final Plumbing - When all
plumbing work Is complete.
rn Final Electrical - When all
electrical work ]s complete.
~
[]J
Final Mechanical - When all
mechanical work Is complete.
Final Building - When all
required Inspections have been
approved and building Is
completed.
[2'] Other ll!" .KrL~
7Jt;v/CF
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
blockin9, set.up, and piumbing .
Inspections have been approved
and the home is connected to
the service panel.
D Final - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
. THE PROPOSED WORK IN THE-
HISTORICAL DISTRICT, OR O~~
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
Lot faces Lot Type. Setbacks
Lot sq. ftg. Interior I PL. HSE GARIACC
IN I
Lot coverage Corner
Topography Panhandle S I
Total height .tl/ Cul-de-sac W I
IE I
BUILDING PERMIT I
ITEM SO. FT. X $/SO. F~= VALUE
Main Ib3~ ,30.71 7U5)~
Garage1'7o~~fr- \ 4: . \C _ ~CftfJ/'(.
Carport
Total Value
,71.~
.~7S.00
I ~."r
.~ /. (,5
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) ~ ~"It.f'\ '; ~
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s) N'
-;?
If,O.#()
Sanitary Sewer
FT.
FT.
FT.
Water
Storm Sewer
Mobile Home
~llA)
/(l~
4n~
~S"E:)
/7~ FO
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
~~
4FD
9tPJ
Furnace
Exhaust Hood
Vent Fan
N' ~
Wood StoveJlnsert/Flreplace Unit
Dryer Vent
~1Hr
~o-c:>
-'-
?, l'h.:>
24 $"'0
/ h Ci)
. - 2.3
J.
~7).73
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
77
28
21.SS'
j~20
ft
Curbcut
ft
Demolition
State Surcharge
..p1Av ,(YJ/bl r?~
,
</f;9, ~'>
<" J22.~).
Total Miscellaneous Permits
(E)
TOTAL AMOUNT DUE (excluding electrical) ~'5"2 ~
(A, B, C. D. and E Combined)
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.
:2-3~ S".l
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Plan Check Fee:
:::r?, S?~ c::,
10 - ~'fl-c;C)
':2 , (.,q 51
f:f3
Date Paid:
)'
i
Recel pt Number:
Received By:
/L/
Plans ~fewed By
Systems Development Charge is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
Av..lV\.ul D ,Q \ Ct I t-,
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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.
Signaturp ~ ( ~
IO/#/rj/
Date
VALIDATION:
RECEIPT NUMBER ') r 2- 7
11- /5"-1'/
:7e~ _00;-;; :'> ~7.k 5//10
~~
--'-
DATE PAin
AMOUNT RECEIVED
RECEIVED BY