HomeMy WebLinkAboutPermit Building 1991-7-26
RESIDENTIAL
PERMIT APPLICATION
.
SPRINGFIELD
Inspections: 726.3769
Office: 726.3759
7/ 5"P.RIf'~OTT t./Y.,.
LOCATION OF PROPOSED WORK,il\'J( L.,T 10000
ASSESSORS MAP' \\ -,<l->' --:",4 -I -:"l
C,;~o..v- I.e.s ...U\')~l'\ IMll..\'Pl'6S
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LOT:
OWNER'
ADDRESS'
CITY'
'"R es ,A~L..
DESCRIBE WORK'
NEW t./ REMODEL
1Se.T",,<..._w
BLOCK:
STAT'"
(fJ I> <'
.
Jlo~
q/a.j-:-L~
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
&si\ ~ ?~e.S(O \\ ~l:
TAX LOT:
SUBDIVISION'
\c90~O
PHONE: 19&3 -441o'l.
(.>>(J.,..c:.
.., 4ln -to <;" \
ZIP:
0. 'T40 l
.
S/\~i~T.~~uo
ADDiTION
1~~
CONST.
CONTRACTOR #
PHONE
7~ -?'<Dele>
CONTRACTOR'S NAME ADD!1S \'\..:\\1
GENERAl' l"t\C.lCQ~"/-k: 1)1\1~ l.o\.J2'l ...., r:-
PLUMBING: B,I\ 13,l\;)e"
( .
MECHANICA" \-4...u~ 0 '?/l.., ~
ELECTRICA"
"
QUAD AREA: \ R ~ ")\1)
\
OCCY GROUP: \<.'(-)
R
'0
. OF BLDGS:
. OF STORIES:
WATER HEATER:
- OFFICE USE -
LAND USE: \ \ \ \
# OF UNITS: \
CONSTR, TYPE: \/ AI
HEAT SOURCE: C" s:;;;;;r. ,//./Z?
RANGE: b .
EXPIRES
'(~/92.
FLOOD PLAIN' -
ZONING CODE: L1J ~
-~
# OF BDRMS'
SECONDARY HEAT'
SQUARE FOOTAGE~q3~
To request an lnspectlol), 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.
~TempOrary Electric
~ Site Inspection - To be made
)AJ after excavation, but prior to
settIng forms.
D Underslab PlumblnglEleclrical/
Mechanical - Prior to cover.
~Footing - After trenches are
~excavated.
D Masonry - Steel location, bond
beams, grouting.
~ Foundation - After forms are
~ erected but prior to concrete
placement.
REQUIRED INSPECTIONS
~Rough Mechanical - Prior to
cover.
~Rough Electrical - Prior to
~ ~over.
1'x1 E:.lectrical Service - Must be
~ approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
~raming - Prior to cover.
rvrWall/Ceiling Insulation - Prior to
~cover.
~nderground Plumbing - Prlor ~ Drywall _ Prior to taping.
~ to filling trench, t'C.:::i
I"':7'f Underfloor Plumbing/Mechanical
~- Prior to Insulation or decking.
~post and Beam - Prior to floor
Insulation or decking. .
~Floor Insulation - PrIor to
decking.
~Sanitary Sewer - Prior to filling
J,L:::f trench.
~Storm Sewer - Prior to filling
trench.
~Waler Line - Prior to filling
trench.
~ Rough Plumbing - Prior to
cover.
~ Wood Stove - After Installation.
D Insert - After fireplace approval
and Instal/atlon of unit.
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
~dewalk & Driveway - After
excavation Is complete, forms
and sub-base material in place.
o Fence - When completed.
I'f.iTi)treet Trees - When aI/ required
~rees are planted.
~inal Plumbing - When all
plumbing work is complete.
~nal Electrical - When all
<C't:=-rcl~ctrlcal work Is complete.
~inal Mechanical - When all
~ mechanical work Is complete.
~nal Building - When all
~eQulred inspections have been
approved and building is
completed.
DOther
MOBILE HOME INSPECTIONS
o Blocking and Set.Up - When all
blocking Is complete.
D 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.
D Final - After all required
inspections are approved and
. porches, skirting, decks, and
venting have been Installed.
Lot faces W Lot TYRe. Setbacks 6s THE PROPOSED WORK IN THE
Lot sq, ftg, /~tJ()O V;. I PL. HSE GAR ACC HISTORICAL DISTRICT, OR ON
_ nterlor IN t'C- , THE HISTORICAL REGISTER?
Lot coverage, L Corner If yes; this application must be signed
~(; Is ~I" ( and approved by the Historical
Topography Panhandle 0,
al/ Iw G8' Coordinator prior to permit Issuance.
Total height Cul-de.sac
IE .:z C/,
APPROVED:
BUILDING PERMIT
ITEM SQ, FT. X $/SQ, FT,
Main
Z"'2q.,!O
9d a. y'R
"39'. "71>
~/c?
Garage
Carport
Total Val ue
Building Permit Fee
State Surcharge
Total Fee
(A)
VALUE
$t;.,r;-~ ZLS
/2..7""f'CJ'.c??
~.~".'25"
.
"I / ~ ()O
fJ. &.7>
4'3t;.75
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
J. Jf1.>f
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N' ;2..
Sanitary Sewer FT,
Water FT.
Storm Sewer FT,
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
"3
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
3D ft
Sidewalk
Curbcut
ft
Demolition
State Surcharge
fl1u'hJ~. rmtl~7OItJ
FEE
1,"0. &0
/6 tJ.~O
!p, tJo
IIO$otJ
C. tfJD
Lf,. ><9
1',~o
I{:, cPO
3,C)0
17.{:o
/t9,t.90
~. )g
y 1. Sf]
I tf. '10
Nj,~.3(
/4-. C;u
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrlcal;!f 2. t~7, 7~
(A, B, C, D, and E Combined) Z '9- 5'-1. (:')3
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, inciuding 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.
Plan Check Fee: -:;Z6t:? 7S"
h-;??-9/
Date Paid:
Receipt Number: ~&_'r'/-=='
.,/ / ~-.--..-
R:~!?~;;' ~, ~
Plans Reviewed 'By
~?/~/
Date
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
JiH !JAIl) t/t= hd30 T
RFq/-IIRr.,e. .
k...t'5=.At'nv/'
, .
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 Ordinanc~s 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 wltl remain
on the site at all times during construction.
X Signaturp ~ ~, \M.~ ';
,,'Uo-C\'
...-
DatE"
VALIDATION:
RECEIPT NUMBER 2~ 8-(7'
DATE PAID _~?t'-/5/
AMOUNT RECElv"n I_~ ?,s-' ~<Y.J
RECEIVEO BY ~~i.1