HomeMy WebLinkAboutPermit Building 1993-4-9
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JOB NUMBER Of 2Cf31~ .
225 Fi fth Street
Springfield, Oregon 97477
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fiiESIDENTIAL
PERMiT APPLICATION
Ins pections: 726-3769
Office: 726.3759
190/
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:
TAX LOT:
WJ..O&"- ~Uvt..Jcj
33
SUBDIVISION:
BLOCK:
LOT:
u_,
I
1J~1o 3~crg
PHONE:
OWNER:
HE AND i CONSTRUCTION,INC #71158
84'35'3 Pax kway
PLEASANT HILL,OR '37455
ADDRESS:
ZIP:
CITY:
)( r/la-p~(1 (!?J
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DESCRIBE WORK:
N EWV
DEMOLISH
OTHER
ADDITION
REMODEL
CONST.
CONTRACTOR 1/
EXPIRES
,F'1j()i'Jj:
ADDRESS
CONTRACTOR'S NAME
"
GENERAL: I
PLUMBING: I
MECHANICAL: J
I
I
726-3898
02/95
84959 Parkway 71158
Pleasant Hill, Or '97455
I
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i
,
HE and i Const"Inc.
687-1851
04/94
Bills Electric 3170 W 11th, 21351
Eugene, Or 97402
Don Lewis Plumbing 500 Greenfield 33076
Eugene, Or 97404
Marshalls Oil & Ins. 4131"E"St, 25790
Springfield, Or 97478
Brooks Excavation 27661 Crow Rd 55921
Eugene, Or 97402
, ELECTRICAL:
,
I
OUAD AREA: ~:
1
I
OCCY GROUP: ~
1/ OF STORIES: ~
WATER HEATER: J
I
688-1931
06/93
747-7445 f
i
II OF BLDGS:
12193
345-7564
03/94
",
.-
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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.
REQUIRED INSPECTIONS
~T~&{,DooJn;cl
D Site Inspection - To be made
after excavation, but prior to
setting forms,
'" '
-0 Final Plumbing - When all
( plumbing work is complete.
rA Final Electrical - When all
~ electrical work is complete.
rr<2inal Mechanical - When all
It:1 ~echanical work is complete,
~ough Mechanical - Prior to
., cover.
~ROU9h Electrical - Prior to
r cover.
~Electrical Service - Must be
approved to obtain permanent
electrical power.
0, Underslab Plumbing/Electrical1
Mechanical - Prior to cover.
rg7~o, oting - After trenches are
( excavated.,
D Masonry - Steel location, bond
beams, grouting.
~OUndatiOn - After forms are
" erected but prior to concrete
placement.
" ~nal Building - When all
Gt1 Fireplace - Prior to facing {""'fequired inspecti.on,s h~ve been
r materials and Jrami..':'g.l~p~ A" J approved and bUilding IS
z,...QJD (IOOe.J..}l.{).A ~ completed.,
tA Framing - Prior to cover.
~ "D Other
'~WaIl/Ceiling Insulation - Prior to
( cover,
~ Drywall - Prior to taping.
D Underground Plumbing - Prior
to filling trench. ,
MOBILE HOME INSPECTIONS
[s;zt un~~~~~~~ ~':~~~:i~~,1 ~re~~~~i~~~
~ost and Beam - Prior to floor
/ insulation or decking.
r::;zp'Floor insulation -=- Prior to
'-t' decking.
~ani!ary Sewer - Prior to filling
T trench.
r::;?( Storm Sewer - Prior to filling
~ trench. "
: I Wood Stove - After in.stall8.tion.
D Blocking and Set.Up - When all
blocking is complete,
D Insert - After fireplace approval
and installation of unit.
D Plumbing Connections - When
home has been connected to
water and sewer.
~' Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Elect~ical Connection - When
blocking, set.up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
q:z;f Sidewalk & Driveway - After
( excavation is complete, forms'
and sub.base material in place.
D Fence - When completed.
G,A'water Line -:- Prior to filling
( trench.
~ROU9h Plum'bing - pri~;'.to
~ cover,
D Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.
i</fY. treet Trees - Wh.er:. all required
Tt'ees are planted, .'
Lot faces
Lot sq, ftg.
Lot coverage
Topography
\5/
Total height
BUILDING PERMIT
ITEM sa. FT.
~
~\~
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
Lot Type
Interior
Corner
Panhandle
Cul,de-si1c
~~@
t~:V
(A)
Setbacl<s
HSE GARIACcl
I
I
-HE PROPOSED WORK IN..t:f1E'
, ,
, h ,STORICAL DISTRICT, OR ON"
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance,
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a~1,_B1
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~ 40
~5\~
SYSTEMS DEVELOPMENT CHARGE (SDC) $
J:J 'Z:z.
(B) Fr IqoS --
PLUMBING PERMIT
ITEM
Fixture?
Residential Bath(s)
>
Sanitar'y Sewer'
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
MECHANICAL PERMIT
Fu rnace
Exhaust Hood
Vent Fan
NO
A
,
FT.
FT,
FT.
(C)
NO
3
Wood Stoveilnsert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERM!TS
Mobile Home
State Issuance
State Surcharge
Sidewalk ,'1 D ft
Curbcut t>- ~C ') ft
Demolition
~te Surc~~~ (\
\, ;VOJ) .'Y\Clf\,-L
FEE
iliA') PJ
ti.
~OfX?
F\ tV
ttBcO
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APPROVED:
BUILQING VALUE, PLAN CHECK
AND BUILDING PERMIT '
This permit is granted on the express condition that the said
const'ruction shall, in all respects, conform to the Ordinance
ad'opted by the City of Springfield, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at anytime
uppn violation of any roViSiO;\\rst; ~rdi~ances.
Plan Check Fee: JL-/
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 improved.
ADDITIONAL COMMENTS
0J)fl,:6tff.iuS\R~
\_~J\V{~JJ~]_)\. (qll:)
GP1th i
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 arthe proper time, that each address is readable
"'frc.ro.' the 3trc:~t, th3i tr.e permit card .is IOC3t~d at the_front
of the property, and the approved set of plans will remain
on the site at all times during construclion,
Signatur~~ if In '~{..}1 ;1; '}
Date
VALIDATION:
~~':,:'~~
Total Miscellaneous Permits (E) ,~ \
TOTAL A",ioUNT DUE (excludin'g electriCal)~dLor::5C(XJ i
(A, 8, C, 0, and E Combined) - . --~- ----- I
ZS~7
DATE PAID_ ~"'?-~9" "
AMOUNT R~CEIVED~,-,\, _, 6], '~, _-5~'t5~.-
Rr:.CEivEu'BY _____ ~-----
.
RECEIPT NUMBER
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
W,ORKSHEET .
, . .
(COMMERCIAL & 'RESIDENTIAL)
, "
'{i~'
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" . .
,.,JOB NO~iq~o~1<6
~;~
NAME OR COMPANY: !Ie 4 r CD~c;,-r~UG1(DJJ. TNc.. .
LOCATION: /Cf57 8c^-l^"E LANE:- LoT ~? - tJ, c..OLE: FA/Z-K
DEVELOPMENT TYPE: /1Jr.. ~ NE:..W SF/2.
BUILDING SIZE:
LOT SIZE
SQ. Ft.
1. STORM DRAINAGE
IMPERVIOUS SQ. FT.
ZSoS
. X $0.192 PER SQ. FT.
c0<<OV
2. SANITARY SEWER-CITY
.
NO. OF PFU'S
(See Reverse)
(9)
. X $39.78 PER PFU
G/(lpo7)
-------- --------
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
( X (,ooS X $401.05
00~v
X
X $401.05
$
0,
X
X $401.05 $
SUBTOTAL (ADD ITEMS 1,2, & 3) $ ! 000 o~
4. ADMINISTRATIVE fEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
0D9
TOTAL-CITY SDC $/fo9,O~!:..
5. SANITARY SEWER-MWM~
NO. OF PFU'S /<6 x $13.62 PER PFU + $10 MWMC ADMIN. FEE $ 25S'~
(Use PFU Total, From Item 2 Above)
0~~LL
'u Kip Burdick
SDC Coordinator
~ l'Zt/-/17:J
, I
b'6
$ ;c-
.TOTAL-MWMC SDC~~~
TOTAL SDC $ /Q052...3::.
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
FIXTURE UNIT CALCULATION TABLE: Number of New Fixtures X Un. ,--luivalent =' Fixture Units (NOJiE,:~:'
For remodels, calculate only the NET additional fixtures) . ,. ,~
> '
FIXTURE TYPE
NUMBER OF
NEW FIXTURES
UNIT FIXTURE
EQUIVALENT UNITS
I
2 tf
1
2
3
6
2 "2-
6
6
1
3
2
1/Head
2 "L
2
1 Z-
6
4 ~
Bathtub........... .............. ........................................ .....
Drinking Fountain..................... ..... ........ .,... ........ ......
Floor Drain..... .... ........ ............................ .... .......... .....
Interceptors For Grease/Oil/Solids/Etc.................
Interceptors For Sand/Auto Wash/Etc..................
Laund ry Tub /Clotheswasher...................... .......... ...
Clotheswasher - 3 Or More.....................................
Mobile Home Park Trap (1 Per Trailer).........,........
Receptor For Refrigerator ;Water Station/Etc........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Stal!... ..... ... .:.. ............ ...... ..... ...........
S hower, Gang......:.... ........................ .......................
Sink, Bar, Commercia!.............................................
U ri nal, Stall ;Wall.... ,..................................................
Wash Basin/Lavatory, Single..................................
Water Closet, Public Installation.............................
Water Closet, Private....... ........,. ,..................... ........
Miscellaneous:
9-.'
2--
1.--
TOTAL FIXTURE UNITS
/'6
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table,
calculate credits separates.
Year
Annexed
Year
Annexed
Rate per $1,000
Assessed Value
1979 or before
1980
1981
1982
1983
1984
$2.83
2.76
2.71
2.60
2.46
2.33
1985
1986
1987
1988
1989
1990
1991
$2.16
1.90
1.60
0,25
0.87
0.50
0.16
Improvement (if after annexation date)
-Z.ls"$ X $ 10. (,
(Rate X Assessed Value) ,
X $
(Rate X Assessed Value)
CREDIT TOTAL
~~
Credit for Parcel or. Land Only If Applicable
-
=$ ~~
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
R esid ential........................................................ 0.4
Com mercial...................................................... 0.9
I nd ustrial........................................................... 0.45
Governmental.................... ................. ...... ........ 0.5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
.-- LP~/ . tlJi
,_~,:\~,::/_''/''''/~EeTRICAL PERMIT A:PLICATION r)
:v'jll~Y City Job Number q,-~{)(3'7 C\
I.{/, A\)~e
,)',,\.6./" c\ S\9;f\'"
~o<<~ 3. COMPLETE PEE SCnEDULE BELOY
LjWJ;.9NIfP ~SI~LA1'I<ON \>-\)'I:
Vf/)'I0fl~i' UU..O J
.
225 FIFTH STREET
Sl'IUNGFIELD, OREGON
INSPgCTION REQUI~ST:
OFFICE: 726-3759
,'r:' _\~,.,( \ .
1..0'" ,- p\'
97', 77 \}.VV'~
726-3769
1.
LEGAL DESCRIP'rION
<::.':JOnr>>~ES~P'fION _~ A
<... ').. r- - ~.i J:V...r JlJl.. flIlo J
Permits are non-transferable and expire
if \Iork is no t s taned within 180 days
of issuance or if \Iork is suspended for
100 days,
2. CON1~CTOR INSTALI~TION ONLY B.
Electrical ContractorJ3;JJ~ ?=" }~c.i:rJ..C-
Address0170 1.,( J, sf \ rth
I Ci-tY~Q Phone3ij3/.2,~-:::S
Supervisor License Number 7tJ ~4f -
Expiration Date /o")-ez3
Constr Contr. Number 2.-/.35 t
Expiration Date
Ll-/- Cjl/
~ ./'
Owners ~rn Q ~ I r ~ 0' D.
Address B4:ClSQ (~1Uu~
ci~~,~i~ PhoncJ9Jrr~
OYNER INSTALLATION
The installation is being made on
property I own which is not intended
[or sale, lease or rent.
O....ners Signature:
I _~_____________________________________
'! .
DATE:
RECEI PT >>:
ltECETVED BY:
'/-9-9~
~~~ 2__
,~_....~ -, ~
New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
A.
Items
1000 sq.ft. or less I
Each additional 500
sq. ft or portion !)
thereof C...J\
Each Manuf'd nome or
Modular D\lelling
Service or Feeder
Services or Feeders
Installation, Alterations or
Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
Cost
Sum
$ 85,00
~
:::i)
$ 15.00
$ 40,00
$ 50.00
$ 60.00
$100.00
$130,00
$300,00
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000
Branch Circuits
$ 40.00
$ 55.00
$ 80,00
volts see "B" above
New, Alteration or Extension Per Panel
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Com~
One Ci,rcui t
Each Additional
Circuit or with Service
or Feeder Permit
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
$ 35.00
$ 2.00
not included)
$ 40,00
$ 40.00
$ 20,00
$ 36,00
'I a)
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