HomeMy WebLinkAboutPermit Building 1995-3-23
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
SPRINGFIELD
LOCATION OF PROPOSED WORK: 5~F'LkA
lOB NUMBER
q~D2..qq
225 Fifth Street
Springfield, Oregon 97477
LOT:
/z
/ 7-C;Z- ~-'i$'- 44
~....2/~,'.~'~~, ~R 9?47a
TAX LOT: 0/6 a=-.
SU BDIV ISION: ib.tLf3,~~.:4 ~77'b l'-r ~
ASSESSORS MAP:
g-r
/
BLOCK:
OWNER: ..::i51'.2..J.,/t'?t=? I' :::Z:>"A-A/,l9- ';l);;>J/~<;'~^~';
ADDRESS: 212.. 7 h';;:>r.~~, S;-,
CITY: ~ 'lLEt:?AF;;s: STATE:'r:;P
DESCRIBE WORK: /:?A-~//.;~-;4/l~:rr../~~: A-..........A="
NEW ~' REMODEL ADDITION" 'DEMOLISH
CONTRACTOR'S NAME
GENERAL: 6RD!Jfil7uJk?,.~"
/I
PLUMBING:
II
MECHANICAL:
ELECTRICAL: ~~P',nL ~~/
QUAD AREA:3R~(,_....
· OF SLOGS, \ ~..l..
OCCY GROUP: ~- ,
\
II OF STORIES:
6-
WATER HEATER:
PHONE: -689-...f? 9J9?
ZIP:
C77404
~L/90~~~~
OTHER l
ADDRESS
...57/2 4l ..aA-;,,./
It'
CON ST.
CONTRACTOR #
4~4;?z
It'
EXPIRES PHONE
//45 7z.6-Z/7/
It'
i'.
- OFFICE USE :-:.
\\Sn
# OF UNITS: \
CONSTR. TYPE: ~,
HEAT SOURCE: ~ E
~
LAND USE:
RANGE:
REQUIRED INSPECTIONS
o Rough Mechanical -:- Prior to
cover. '
o Site Inspection - To be made 0
after excavation, b~t rior to
~ for s. ~. ~
~ unde,~~~~t IElec";c"~
Mechanical - Prio cover.VO
Rough Electrical - Prior to
cover.
Electrical Service - Must be
approved to obtain permanent
electrical power. .
o
Fireplace - Prior to facing
materials and framing Insp.
I~,
/1'
//
FLOOD PLAIN:
ZONING CODE: \ DR-.
# OF BDRMS:, ~ /
SECONDARY HEAT: ~
SQUARE FOOTAGE: \lBL
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
/'
~Footing - After trenches are
, excavated., _
o Masonry - Steel location, bond
beams, grou,ting.
~ndation - After forms are
erected but prior to concrete
placement.
o
Underground Plu'r'nbing - Prior
to filling trench.
o
Underlloor Plumbing / Mechanical
- Prior to insulation or decking.
o
Post and 'Beam - Prior to floor
insulation, or decking.,
o Floor Insulation - Prior to
decki ng.
~anitary Sewer - Prior to filling'
~ ~'ench. . '
r-I--<Iorm Sewer - Prior to filling
~ tr~'nch. '
.-. '~r Line - Prior to filling
~:~~h,
o Rough Plumbing ::- Prior to
cover.
o Framing - Prior to ,cover.
o Wall/Ceiling Insulation - Prior to
cove~ '
o
Drywall - Prior to tap,ing.
'0
Wood Stove - After installation.
D Insert - After flrepla~e approval
and installation of unit.
,/ . I
~urbcut & Approach - After
forms are erected but prior to
placement of concrete.
~Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
o
Fence - When completed.
o
Street Trees - When all required
trees are planted.
'\
o
Final Plumbing - When all
plumbing work is complete.
o Final Electrical - When all
electrical work is complete.
o
Final Mechanical - When all
mechanical work is complete.
o
Final Building - When all
required inspections have been
approved and building is
completed.
D Other
MOBILE HOME INSPECTIONS
l::::::J Blocking and Set-Up -' When all
blocking is complete.
.......-
b:::j Plumbing Connections - When
home has been connected to
water and sewer.
i1...Ehfctrical Connection - When
~ blocking, set-up, and plumbing
inspections have been approved
and the/home is connected to
the s~rvice panel.
2:1 - After all required
G2(i~~~ections are approved and
porches, skirting, decks, and
venting have been installed.
~.
Lot faces
Lot Ty~
Lot sq. fig.
Interior
Lot coverage
Corner
Topography
Panhandle
ILV
r 11 '1
BUILDING PERMIT
Cul-de-sac
Total height
ITEM
SQ, FT.
X $/SQ, FT.
Main
Ga..ge ~.-
~rl
M,)
Total Value
(p,O/X)
Building Permit Fee
State Surcharge
Total Fee
(A)
;~~~;!,fL,~'" ' " . ".:;.: .
i!ll~;:!llli~.v:;!.~"';.I.""'~:"~ '-" \~.-... :If""'"I'.!'
'~l!'~,,: "di:~. f' ", -. ',' " - ~'. ..4 ."j"
ii.'i:!1W:\tfSetlJac'ks' ;,\' .;"
I' :F{L' HSE GAR I Ac2 I
IN
\S
Iw
IE'
VAL~Io..^
:13,~
I, O(){)
5QW
l
1Qt:D
5.0\
111f).51
SYSTEMS DEVELOPMENT CHARGE (SDC)
, (B) ff>2..'1'E:>~ ~
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
NO
Sanitary Sewer
FT.
Water
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge -\' ~
Total Charge (C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
Wood Stove/lnsert(Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sldewalkffl
Curbcut o?- II
~.-,-.y.;;:~ .::3Qo
II
State Surcharge
FEE
65J:1)
&5fP
gsOO
.~
~( .()J
/
~
\If)~
~O.OO
~.~
A3 -0::>
-~4 .ff)
~;\~
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electricaIN~~ .~~
(A, B, C, 0, and E Combined)
IS THE PROPOSED WORK 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 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.
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 Improved.
ADDITIONAL COMMENTS
\
---
A.:;\ I,
6l'3\ ~_t{)
,,_Af\\~'{Jd ~t\.LL'.
\ C\l Of)
~"'~aJ.JL
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 lime, 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 plan~1 remain
:::::u~e al y~zo. .
,-
Date ....:r-?~_9S
VALIDATION: · 1'7 rz...
RECEIPT NUM~R ll()7~
'DATE PAID O'~2..3-Ck A/\
AMOU~T RECfl~D ' N Lf - _ ~
RECEIVED BY 'eh
ATIACHMENT B1
.J NO. .Q602P/9-
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: f)OYCr::-.. 4- DIA^-IA DR.L1SW
LOCATION: 57Cf'Z. ('A-MC'--Ll-tA Sf. 17az~?4-4
DEVELOPMENT TYPE: LVI(.. - tJ6wrv1AIJU. -I-/OMc
P.lV /-J()M E. GNlA6E
BUILDING SIZE: /~-I. '2-c, '2ca >< <p5.~'?>. ZZ,l34- LOT SIZE
- 0 I b{) 3
SO. F t.
1. SJORM DRAINAGE c(~I?'~
IMPERVIOUS SQ. FT. -Z9 ?1 X $0.209 PER SQ. FT.
2. S8tllIARY SFWFR-ClIi G/f6;;
NO. OF PFU'S ('6 X $43.26 PER PFU
(See Reverse) '-- .--/'
3. TRANSPORTATION
~o 5?)
'-- ~
$
$
SUBTOTAL (ADD ITEMS 1.2. & 3) $ f ~?;'3~
NO OF UNITS X TRIP RATE X COST PER TRIP
I X I. 0 I X $436.19
X X $436.19
X
X $436.19
4. SANITARY SFWFR-MWMC
NO. OF PFU'S ;<6 x $17.19 PER PFU + $10 MWMC ADMIN.FEE
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL-MWMr: SIX
SUBTOTAL (ADO ITEMS 1.2.3 & 4)
5_ ADMINISTATTVF FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
~~~~
i1P~Qrn i~. ~~
SDC Coordinator
Date: NlA~. ~~ 19'15
/
IQIAL SOC
B2.SDC .
$ ?;, I q 4.:!
$ ~o~
($ z:z;,q !2 )
$ "2. b 7 '2. "Z..-.!.-
C:lo~;j
---- ---
$ "Z If? ~3:
FIXTURE UNIT CAlCUlA'T N TABLE: Number of New Fixtur(
:'.<1 ... ........,.
(NOTE: For remodds,calCulate only the .ufI additional fixtures)
NUMBER OF
FIXTURE TYPE NEW FIXTURES
Bathtub............................................. ............... ..........
Drinking Fountain................................. ........... ...... ...
Floor Drain...... ..................... ............... .... ..................
Interceptors For Grease/Oil/Solids/Etc............ ......
Interceptors For Sand/Auto Wash/Etc..............~::. '.
laundry Tub/Clothes.wasl:1er. -........ ......... .~........ ........
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 Stall.............................. .............. .....
Shower, Gang...... ..................... ......... ...............~~.....
Sink: Bar, Commercial, Residential Kitchen........................
Urinal, Stall/Wair::........ .'.. ........... ......... ..... ....................
Wash Basin/Lavatory ~ Single............ ......................
Toilet, Public Installation................................ ....w.
Toilet, Private................................................... ,...
Miscellaneous:
z..
. "';
. .
.;. ~"'
.. ..'~.
I
:2--'
'2--
TOTAL FIXTURE UNITS
Unit Equivalent =. Fixture Units
UNIT FIXTURE ,.
EQUIVALENT UNITS
2 4-
1
2
3
'6
2 '2
6
6
'1
3:
2
l/Head
2 "2-
2
1 '2.
6
4 ~
If,
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table,
calculate credit:;; separates.
Year
Annexed
Rate per $1 ,000
Assessed Value
Rate per $1,000
Assessed Value
1979 or before
1980
1-981.
1982
1983
1984
1985
$3.46
3.38
3.32
3.21
3.06
2.92
2.73
Year
Annexed
1985
1986
1987
1988
1989
1990
1991
1993
$2.46
2.14
1.77
1.37
0.97
0.61
0.44
0.15
\
Credit for P,arcel or land Only If Applicable
8023
Improvement (if after annexation date)
o.4-fo X $ 'Z.?'2-
(Rate X Assessed Value)
X $_
(Rate X Assessed Value)
=
CREDIT TOTAL
= $
~c '21
\,
f'
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
1. _LOCATION OF INSTALLATION
'~,)3'1Cf1J...... ~(ltJ tv
LEGAL DESCRIPTION
, 11 6'1; IJIh till tJ I {Po?,
.^.. ..,^:.o i_B/~ D7WESCRI ,PTIONV /.' . '1)
~_ 1:/)/1. f'" 'P1JI'-
ELEcTRICAL PERMIT APPLICATION
Ci tyJob Number at6 OIJA q
..
3. COMPLETE FEE SCHEDULE BELOY
c
A. New Residential-Single or
Mtil ti-Family per dwelling uni t.
Service Included: '
.~
Items Cost Sum
iooo sq.ft. or less $ 85.00
Each addi tional 500
sq. it or ,portion
th~reof $ 15.00
Each Manuf'd Home or
.' Modular,Dwelling k jO,~
'. ~.. Service or Feeder $ 40.00
.- --
Permits are non-transferable and expire
if work is not started wi th,in 180 days
of issuance or it work is suspended for
180 days.
2. CONTRACTOR INST~~TION ONLY
Elee t ri eal Con t rae ~ JlJ(\ -\o..l1\9---
'Address \\J\9 _\. ~ ~Q ~
Ci ty € J... 1) eACLPhone ,,\~. \W
S . -L\ N b. , LP~8~npC()
uperVlsor lcense urn er Q 4~;J..<:;'
Expiration Date \ n. \ .Q5
Constr Contr. Number \p~ \ ~')
Expiration Date \ ~ . 8..~' qcq
< ;
Signature of Supervising Electric~an
'~.~
. "t/ .., . ' D.
Owners Name ,fJa!:Ju.4.J/([U1.lV DVt.dbot
Address~v'.( ~. '
City ~I..vu Phone'~:IJ.~A~aZ,
OVNER INSTALLATION
Th~ i~stallation is ~eing made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
DA~E~---------~~2J2)..~------7~---
RECEIpT #: I_U _ _ _. \~.J ,
nurouTupn RY' ~
B.,
Services or Feeders
Installation,Alterations
or Relocation: '
200 amps or less
201 amps to 400 amps
401 amps to, 600 amps
601 am~sto 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 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
One Circuit
Each Additional
Circuit or with Service,
or Feeder Permit
s.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
E. ,Miscellarieous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
$35.00
$ 2 . 00 _t . bO
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
~~,~
4'" , ()
'l..:l.ttt
~ ~,.6lf-
'1
.t\~ Willamalane
~'W. Pa,k & Recceat;on D;st,;ct
Job No. .9S-f)~qq
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME: ~ ! pi4KlL l)r"U':-fV1
ADDRESS: .-_~t,J;p1/ "f..qVtJV(/ ~.
PHONE: & ~q- ~.!l.E-7....
STATE: 0(4. ZIP q1 L(04
'.
LOCATION OF PROPOSED BUILDING SITE: ,; .
-Street Address if'Known: 0Jq?/ ~j~)..~ 42.......
, , ,
Platt ~ame: ~{ll...... ~Tax Lot Num~r: \1 D ~ % L/4 () ( &00
1. DEVELOPMENT TYPE (Check appropriate dwelling(s>. SDC Calculations and dwelling type
definitions are on the back.) ,
A. Sim!le Familv - Detached
, _,n Single Family home
NO OF UNITS 1
B. Sin'!le Familv - Attached
\
NO OF UNITS
C. Multi-Familv Aoartment
Manufactured home not in a park .' ,rf)
$MJD.,
x ' $400 PER UNIT _=..
.
X $370 PER UNIT =
'$
NO OF UNITS
X $~77 PER UNIT =
$
'D. Manufactured Home Park
-'
NO OF UNITS
- IX $280 PER UNIT =,
$,
, $ '4l)O,cD- .
$:tI
$~~4-lTI~ -
WPRD SDC
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRO Credit
approval. See SDC Credit Worksheet. . ,
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced (or Credit>
~O~
r,..,..,,....,~;.,, c;,......,;,..,.... n-y.;;,..,",
?;? IIJ.1J I tis
nAtr.> '
I