HomeMy WebLinkAboutPermit Mechanical 1992-2-5
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK: 13CRO
ASSESSORS MAP: ,'I 0-:; ~I "1.."2..
LOT:
OWNER:
\<. \.G~t>.<<....O
~r...\L..€
ADDRESS: "2... ~oo D,(::..VF. e" L-.. '7'
CITY: S?e-l ~{":~~lli>.\ .0
.o€ V'tl2...L. Y
BLOCK:
STATE:
f)1(
DESCRIBE WORK: l<E..\;-\-A-6 ~ \:>PL ~ I ':'l..,.. ~:L")..q
NEW
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERAL: J",...+:. BL'l'-~c.k:.l.-p> aIJ~:
PLUMBING:
MECHANICAL:
ELECTRICAl'
QUAD AREA:
tI OF BLDGS:
OCCY GROUP:
tI OF STORIES:
WATER HEATER:
JOB-NUMBER.f!llI C120 liS-
225 Fifth Street
Springfield, Oregon 97477
TAX LOT: 4- (0 ~
SUBDIVISION'
4 '
PHONE:
ZIP:Q"74'1
DEMOLISH
ROT Kt.f'~Ie.
OTHER {y E~A<;
v -
REQU I RE DI NSPECTI 0 N S
.0 Rough Mechanical - Prior to
,cover. ','
.0 Rough Electrical - Prior to
cover. .
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
~ Framing - Prior' to cover.
o Wall/Ceiling Insulation- Prior to
, cover.
D,,prywall - Prior to taping.
D Wood Stove - After installation,
D Insert - After fireplace approval
. ,. and installation of unit. '
o
Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Oe.~
. S l1. ., (/,.A.
CONST.
CONTRACTOR tI
PHONE
ADDRESS
- OFFICE USE -
LAND USE:
/I OF UNITS:
CONSTR. TYPE'
HEAT SOURCE:
RANGE'
EXPIRES
4/1 Dlq~_
FLOOD PLAIN:
ZONING CODE:
/I OF BDRMS:
SECONDARY HEAT: .
SQUARE FOOTAGE:
TOTequest 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.
D Temporary Electric
D
Site Inspection - To be made
after excav?tion, but prior to '
.setting forms.
D
Underslab Plumbing / Electrical/
Mechanical - Prior to cover. '
o
Footing ~ After trenches are
excavated.
D
Masonry - $teel location, bond
beams, grouting..
D
Foundation - After fonTis are
erected but prior to concrete
placement. .
D
Underground Plumbing - Prior
to filling trench. '
D
Underlloor PlumbingiMechanical
- Prior to insulation or decking.
o
Post and Beam - Prior to floor
insulation or decl<ing.
,.
o Floor Insulation = :Pi'iorto
decking. . .
D
Sanitary Sewer - Prior to filling
trench.
o
Storm Sewer - Prior to f(lling
trench.
D Water Line - Prior to filling
trench.
o Rough Plumbing - -Prior to
cover.
o Sidewalk & Driveway - After
excavation is complete, forms
and sub.base material in place.
D Fence - When completed.
o Street Trees 7 When all required
. trees are planted. - .
D
Final Plumbing - When all
plumbingworl< is complete.
D Final Electrical - When all
electrical worl< is complete.'
o
m
Final Mechanical - When all
mechanical worl< is complete.
Final Building -When all
required inspections have been
approved and building is
completed'.
o
Other
MOBILE HOME INSPECTIONS
D Blocking and Set.Up - When all
1)locking is complete.
o 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.
D
Final - After all requi red.
inspections are approved and
porches, skirting, decks, and
venting have been installed.
Lot Typ Setbacks
Interior Pl. HSEIGAR ACC
Corner N
Is
Panhandle
\W I
Cul-de.sac
IE I
Lot faces
.\
Lot sq. fig.
Lot coverage
Topography
Total heigllt
BUILDING PERMIT
ITEM
sa. FT.
X $/ sa. FT.
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
:\ r
Total Fee
(A)
VALUE
500,07.)
'/,$'; Db
,.7r"'
/s; 75,-
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) NO
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
Mobile Horne
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
I
i
/'
Wood Stove/Insert/Fireplace Unit
Dryer Venl
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
Total Mis'cellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
~/....c: 7.s.-
IS THE PROPOSED WORf< IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
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 grant,edpn \~e 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 suspende'd or revoked at any time
upon violation of any provisions of said ordinances.
Plan. Check Fee:
Date Paid:
Receipt Number:
Received By:
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improvecl.
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 Slale,of/Orenon perlaining to the work described
herein; and L1)at 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 willl ORS 701.055 will be used on this
project.
ti'
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.
.{;ignature ';::{2 -,1 ~
v ,'" ~
;;z. - l.t:: - '1 d...
-------
Date
VALIDATION:
00 ~ (p(p C:J
RECEIPT NUMBER
DATE PAiD _ :;l..L~q"1-
AMOUNT RECEIV~DI ~ ....,,<5= {\ \'\
RECEIVED By0~ ,,~