HomeMy WebLinkAboutPermit Building 1990-11-6
Reaeipt ,I{
/ Rio c<:--1
... RESIP~~TIAL-..
APPLICAtS);i'"!f;yPERMIT
225 North 5th Street
Springfield~ Oregon 97477
Building Division
726-3753
. ~.
r'
Lo ~'3 ~ A:sur' Sl1\ 00 r
# .I-I)Dd3t~1 Tdwt#m~
Job Loaatian:
Asaesaorz Map
SUbdivision:
CAmel': .\ )\ l0_\CL/A(lli~e\.ln ]
Address: l D'1 f) lo uf\~~X'"~
City' ~)L\~fQ~C'D) ~
Date of Applicatien
Contracto~~ Address
'General L\..A.. ~JC1
; Plumbing'1rn.ij.JL.LA,\-Jlro~ .' ,
, Hechanical :-\. \ \ \l f..-)\ '8,~~ '\~\ J\ \0\ O_A~
EJ,~ctri!:al \D\ ~\L ~ .'
S 11 pe!7'!.lrt!;;T.1g~~ec t r ~ c i<l n
New
Additien
l Rem~del
RiD,
r _(orq,O
I ,'.[obi le lloma
ID
~
o
FOOTING 'l FOUNDATION: To be made
after.trenches are excavated and
forms are erected, but prior to
pouring ecnaret~.
UND'SRGROU.^!D PWM3ING. SSWER, W.1TER,
DRAIt/AGE: To be made priol' to fi l-
Zir.g trenches.
o
o
Ut/DERFLOOR PLUMBING & MECHANICAL:
To be made prior to installation of
11001' insulation or decking.
POST AND BEAM: To be made prior to
installatien of floor insklation or
decking.
ROUGH PWMBI!}G. ELECTRICAL & MECll-
ANICAL: No ~ork'is to be covered
,until these inspections have beer.
made and apPl'oved.
FI~EPLACE: Prior to plaair.g facing
mater'ials and before framing inspea-
tion.
pRAft1JNG: Must be requested after
approval of rough plumbing, aleatri-
aal & meahanical. All roofing
bracing & chimneys, etc. nr~st be
completed. No work is to be con-
i ceded until thin inspection has
'been made and approved.
o
o
D
o
Phona: f\4fl- Cl ~()~
Zip: ql4l~
,
Value
J () (y)(), dJ !
~
or~
Sig"d,Mf/Y1 J_
Date: '~//--I/J -C//)
Expices
,
Lise. . It
Bldrs Board Reg.
Phon?
t () St Or'-,} ~
~ ....
4/n/Gf J
., -,
D INSULATION/V/lPOH BARRIER INSPECTION:
To be made after all insul~tion a~~
. required vapor barriers are in place
',;": ;'.'.-' but before any lath, gypswn beard or
wH covering is applied, and before
any insulation is concealed.
r:-yDRYWALL INSPECTION: Te be made
~ r;fter aU drywaU is in plaae,
. but prior to any taping.
, ,
D MASONRY: Steel location, bond
beams, grouting or verticals in
aaaordance with U.B.C. Seation
2415.
D
WOODSTOVE:
cempleted.
After installation is
DEMOLITION OR ;'.:OVED BUILDIi/GS
==:J Sanitary s~~er ~apped at prop~rt~ lir.e
'; .", I , ...\1 J.~~l, 11",IJI:~IH:'~li"';'r'~I~~~.!",jji rfl~"fhIL .'~'~'
:==J Septic tank p~~ed and filled with gra~el
I Final - f.'hen above items are aompleted
~ and when demolition is complete or stru~-
ture moved and premises ~leaned up.
, Mobi le Hemes
~ Blocking and Sat-up
=:J Plwnbing aonnections s~er and water
~ Electriaal Connection - Blocking, set-u~
~ and plwnbing aonnections nr~st be approved
before requesting electrical inspectio~
=:J Accessory Bui lding
I Final - After parches, skirting, decks,
~ etc. are completed.
o
AU :project aonditions, auch as the installation of str'eat trees, 'cO."'1pletivn of the
required landscaping, etc., must be satisfied before the BUILDINC FINAL can be requested.
It is the responn~bility of the permit hoUier to see that all innpections are made'at the'proper time, that each ~ess is readabZe
from the street, and that the perrrrit card is lCJCated at the front of the property.
'Bui!ding Division approved plan shall remain on the Building Sits at all times.
P,70CSDURE FOR INSPECTION RE'QUEST:CALL 726-3769 (reaorder) state your City designated job number, job address, type of inspecticll
requested and when you will be ready for inspection, Contractors or OWners ncme and phone number. Requests received before 7:00 ~
..'ill be made the same day, requests made after 7:00 am will be made the next :uorking day. qo' j"?" ~ i A _"
Your City Deaigr~ted Job Nwnbcr Is: ,--~-~ .
Reouir>ed InsDp.ctiens - I
SITE INSPECTION: To be made after
excavativn, but prier to set up of
forme.
UNDERSLAB PLUMBING. ELECTRIC,1L &
MECH,lNICAL: To be made before any
work is covered.
~ FINAL PLUMBING
Q'FIN/lL MECHANICAL
~INAL 'ELECTRICAL
0'
FINAL BUILDING: The Final Building Inspection must be requested after the Pinal Plwnbing
Eleatrical, and Mechar.iaal Inspec~iona have been made and approved.
[]
~RB & APPROACH APRON: After forms
~~e erected but prior to pouring
concrete.
. n.. SIDEfMLK & DRIt'EW:Y: For all con-
~ crete paving within street right-
of-uJC.Y, to be made after aU exca-
vating complete & fo1':71 work & sub-
base material in place.
D
~ENCE: 'h'hen.complete -- Provide
gates or movable sectienn through
P.U.E.
'AU !.f/lNHOLES AND CLEANOUTS !1U8T [iF: ACCESSIBLF:, ADJUST!fENT TO BE MIIDE n NO ('(1ST TO CITY P~fle! of 2
o
. -oJ'" -
JOB NO.
SOL A R Aloe E S S R E Q.-
L -CO c-1t
'" .
Zone:
Occupancy Gre
LOT TYPE
Type/Const:
Bedrooms:
Lot Sq. Ftg.
Z of lot Coverage:
Ii of Stories
TotaL Height
Topogl'ilphy
[,at Faces -
I I Enerrf!! Sources
I I Heat
Access. I I Water !/eater
I I Range
I I Fireplace
I I Wood;;tove
I I
T'IDe
PanhandLe
CuL-de-sac
Setbacks
P.L. House Carage
North
East
South
f"est
Interior
Corner
-- Fees
ITEM
SQ.FTG
x
Value
Building Value & Permit
Main
Garaae
This permit is granted on the express condition that the said construotion
shalL, in alL respects, oonform to the Ordinanoe adopted by the City of
SpringfieLd, inc!uding the Zoning Ordinanoe, reguLating the oonstruction
and use of buildings, and m~y be suspended or revoked at any time upon vio-
Lation of any provisions of said Ord~r~nces.
Carport
Aooessoru
Is. D.C.
TOTAL VALUE
(vaiue)
1.5 x
BuiLding Perrrrit
Plan Cheok Fee:
Date Paid:
I Recdpt 1/:
I Signed:
State Suroharge
Total Charoges
I ITEM NO.
I Fi:I:tures
Residential (1 bath)
FEE
Plumbing Permit
Water
No person shaLL construot, instaL!, alter or ohange any new or existing
pLumbing or drainage syste~ in whole or in part, unLess suoh person is the
Legal possessor of a valid plumber's license, except that a peroson may do
pLumbing work to property which is owned, leased or operated by the appli-
cant.
Sanitary Sewer
Plumbing Perrr.it
, -'-
State Suror~rge
-J
..
- I ~
Total Charoes
ITEM
NO.
FEE
CHARGE
Electrical 'Permit
Res. Sa. fto.
Naw/Extend Cirouits
Temporary Servioe'
Where State Law requires tr~t the electricaL work be done by an Eleotrioal
Con trao tor, the eLeotrioal portion of' this permit shalL not be valid until
the LabeL has been signed by the ELectricaL Contraotor.
Eleotrioal Permit
ITEM
. NO.'
,.--...
\[\ \~ -,)
.~~
Mechanical
Permit
State Suroharge
Total Charfies
FEE
Furnaoe PTU' S
Exhaust Hood
Vent Fan
W:;odsto:Je
Permit I;;suance
Total Charoeo
-- ENCROACHMENT --
~.ou
\;;}Sl
.&/ O,~S I ~
Mechanical Permit
State Surcharae
Se~~rity Deposit
Plan Examiner
uate
Storage
Pormit
I TotaL CharGes
I eurbcut
I Sidewalk
I Fence
I Electrical Label
I Mobi le Home
~
I HAVE CAREFULLY EXAMINED thE compLeted applioation for permit, i:md do
hereby oertify that al? info~ation hereon is true and oorrect, and I
fUrther certify that any ar~ all work perfor.ned shaLL be done' in aocor-
danoe with the Ordinances of the City of Springfield, and the: L<<~s of the
~ State of Oregon pertaining to the work desoribed herein, and that NO OCCU-
PANCY wiLL be made of any struoture without permis3ion of the Building Di-
vision. I further oertify that o:'lly contractors QJui e.~pL:;yee8 who are in
o~~pLianoe with ORS 701.05S will be used'on this projeot
Maintenance
I TOTAL AMOUNT DUE: ~
~
I
I
f
I r--??
. ...1.' \-J
110, r; ~ . ~.iall~d
f."" 'I,
r-. D~ "_s\ ~~.'"
~t\\ l\ t>x0
./
.'
Permit No: q () ::-6( __0
Address: {O~~~ <i\Asr~ r S+ .
Iss.ued by: )t;p I [)(D Da-te: J / / ~Jq() .
(....:.. J) _ I I 7-
'STA TEM ENT:
, INFORMATION NOTICE TO PROPERTVOWNERS .
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law,ORS 701.055(4), requires residential building permit applicants
who are not registered 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 2A or 2B:
.1.1\.,]) lawn, reside in, or will reside in the completed structure.
2. fi. I' My general 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.
I 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 general
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.
-------' \-",- \ , \'\
"'-5'- '\. ~ ~ .r \. \." r<:~'" ,,\.1 'l
Signatille-ol-PermitApplicarH - - -
C.r-...
\ \ .
\\ \\~\ ~\ CJ
Date \ \,
CONSTRUCTION CONTRACTORS. SOARD', ;
0244J 10/24/89,
p' ,
~l/l1 .' , . . "
wt:Iij=E COpy TO ISSUING AGENCY PERMIT FILE
~PY TO APPLICANT @.'
Pending issuance of a policy, at which time this Binder will be void, and subject to all the declarations, terms and conditions of the
policy hereby applied for as currently being issued by the Company designated hereon, this Company is hereby bound to the insured
applicant and legal representatives on the property as described hereon for a term not exceeding ninety (90) days from the effective date.
It is a condition of this Binder that, in the event of a loss before the expiration of this Binder, the premium due this Company shall be
fixed at the full annual premium for the sum insured. ': '.', ,I,
This Binder is made and accepted subject to all the foregoing and shall not be valid unless countersigned by the duly authorized
agent of this Company, . . OJ" ".'- :, '.... " ''',)'.' .
)',,',. 'C)/~';tl": ~
..."d.~~~f . ....,~...~,!I.l"t;;;;~/~
'("""j')l ; ~ ,~~tyC4yc
, t. J:,-,'" ':";::"::""l~"tf.<,:, I ....."'.. " .
HOMEOWNER'S/CONDOMINIUM ~te Fann Fire and 0 State Fann General
UNa.TOWN~R'S BINDER-RECEIPT ~C::sualtv Company Insurance Company
NEW' REW.' E OF I 'COUNTRY' OF POLICY NUMBER , FjF.Erl.VEJ!!. JEr/1'/'.." I TERM
II: : : HOME : {", l .
. ,~
I LA~T NAME. FIRST NAME I
I- ~~'::,~rint ,(I ( , / cJ / I J j J I { /-{ /-) ( I...... i') .
Z\ Mailing UNIT ANO/OR STREET ' JI~. ~l..~.NP STRE'ET. ) r -r .' Cl7
() address ff'..jr~ ./,(-" /'-f ) I ('1/ ->
:J Location (IF DIFFERENT FROM MAILING ADDRESS) ,
&: of premises
<l.. TOWNSHIP
OFFICE USE ONLY
M~ iME O~INITIAL
(1.((,1,1""-}
CITY OR TOW}"" 1 .
_'".)~ rJ 6
\ A7.I,!<;ANT"S BIRTh. ?J
- J _ /. J, ., ~
r r' " I
: soc. ,!AL SECUI!I..TY., NU~'Y'!'l ,. J I"~ SPOY~FS ~IRTHD..y Ed
: .!/L/ '/ 'lL If-..) 'I II ~ -;L ,,~J
': t. f
'..t:;'t"{ .r'.~:I;.~
U\::l:.J. -'.:.',;:'0",) !C'r ~ ~f"' _~'It!..~ :.:1.
Dated a,t/k~/',I(l~/il1/
; -; t/r ,
· -I.... . ";?" "'iL/((...'
- .)~;j,~~ ,",,',""1'....", "J~l...{....i '
th is f.? '--
J' )~..'i I' ','
..,f,C<' ;:..)p'.
.,\...;,;,;;.'
,
j") {,; , . ~
:',:; ?: :;. ,i
, !;: -~~..
~Jf""" f t ,.,,.~J" :
..:.L~!r;";iJ~ .j..: ;~h;.J
SPOUSE'S FIRST NAME AND MIDDLE INITIAL (IF APPliCABLE)
. , ZIP'<;opEp
'1'lL/I/ d'
ZIP CODE ; COUN7 .'
, ,/!JV {/,
'Sp-CIAL SECURllY NUMBE;R .'" I TELEP!'J9NE NUMBEP_.. P. f'
itJ j(7 (') r~5~ ( '/'(/1 7 -~ 0(")
(' flATE
/
lB'H
DB
. I ~~i ,I:: ,.'j 'I'
!,,; ~ . t,
,19fo
. Agent
~~~~~~S:;I.
KAY W. VINJE President
STATE FARM INSURANCE
CORNER OF 47th & MAIN
111 So. 47th
Springfield. OR 97478
Ph. 747-4266 .
t/~/~
Secrelary
, , , '('
Form: 0 1 0 3' I 4 0 ". 6
I I I I d
, . I ,.',
Deductibles: ; $.J!;tJ
: . Date Policy Book Delivered
I
I
: O'her (Specity)
'$
J
') .Limits, _ ~ ..
$ - - - (,-- (('( -
: 7 ~:::r:'~=lTY
I Application)
I Theil
I
~$
~CWelry and Furs (JF)
CJ) ubmitlist of items)
I- 1000/2500 0 $1500/5000
L
W Silverware Theil (SG)
~ 0 (submit list of items)
m Tolallimit $
LL.
o r\..l'leplacement Cost-
$ .mmmm Cl Y'Contents (RC)
rrWTT.ry',1WL .
r , 7' r 1'" Z' ,'Z~'I::!:!.. 0 Firearms (FA)
, I " r 1'" Z ','ZZ'en
, II' { ,;., z :rZy.:z 0 Incidental Business (10)
'fJ Lt<.:.( ',',0 (describe In Remarks)
,J,./ Z. ". /. ,.".1-
, . " /" jQ. 0 Business PursUits (BU)
" 'j 7 '.' .' '~'Il '0 (describe In Remarks)
~., .,./., ",7.' '1 j
'J:~ ,.';):: ':'ZZ :,' ~ 0 Home Computer(HC)
" . ,/,1./,..j
l}, ..Ii /' ,I 'XU .j MPP
~~ j-~~ ,rt:(/Jlrl.j Ace!. No
Copy - 0 Insured ENDORSEMENT BILLS:
o Mortgagee
?YE NAME AND ADORES,S)
, ~ / 0 Loss 0 Named Add'llnsured (explain {....-r (1/ /.)/ JJ ((.I
!Z LYMtg. Payee J ontereston Remarks) (~i' ....
a: ;;JC~)~lU' r (1/)/X /f';'-:S ~.;//ifJ I L
w
I '2nd
b o Mtg,
Base Premium
Dwelling or
building property
.oWeliing extension -
W (total amI. incl. 10%
<.9 Irom Cov, A)
<t: -I
a: cj Personal property
Ww
6 en I Loss of use
U (add 'I living expense)
$
'-:OJ r('{)
$. ,~.../ .,.)
Actual Loss Sustained
Condo. loss assessment
(Complete section on back)
$ ,
~~r4tYC
= Personalliability
r i, (each occurrence)
~ Medical payments to
others (each person)
j RENEWAL BILLS: Original -
in
,
$1,000 : $
[J.,(nsured .
[J Mortgagee
TOTAL
, PREMIUM $
Original - 0 Insured
o Mortgagee
.I' S')!/-JtI r/J 1"))' I') I} VI 's
ZIPC~PJ~/1.t~oan
( number
(GIVE NAME AND ADDRESS)
Loss
o Payee
O Named Add'llnsured (explain
interest in Remarks)
OSvc.
Agt
ZIP CODE
I understand that coverage is ol6i~ding 0 not binding under this application.
I hereby apply for the insurance indicated and represent thaI I have read both sides of this application
and the statements hereon are correct. I undersland that the premium shown above must be in
compliance with the Company's rules and rates and is subject to revision.
Agent's Code Stamp
Applicant's . - ,---- -
'. Signature X "
"-.,
Premium
Premium
o Merchandise Samples (SA)
(describe in Remar1<s)
o $2500 0 $5000
o g~;i~~~~~~r:~~~nd
$
$
$
,
o Earthquake I
Endorsement 0 Ded. _ %
- - - - -. - - - -, - - rYES '-NO
Does dwelling have 0 0
masonry veneer? "
-------- -,IY-ES-I,NO-
II yes, is coverage
I desired on veneer? 0 0
I o Other:
$
/1 II:!
: Amount / ~ 'J' . ~'
~ paid $ (r
Copy - 0 Insured
o Mortgagee
fk }/;') /It/-/ k.J;(l~ i
I
Mortgagee
.ubset cod..
Loan
number
Mortgagee
subset code
Date and Time
01 Application
Mo, Day
II /,
Yr.
%0
...,
!../
lli:M.
oP.M,
Houri
, I
.; I'