HomeMy WebLinkAboutPermit Building 1995-3-24
"
RESIDENTIAL
PERMIT APPLICATION
"
OWNER: C.l'('..~ i.' \ AVV'l ~('\c;..l~
ADDRESS:' 3~ 1'-/1 EJA..:"'.7'2V<'{ L.JC\.-Nl~
CITY: ~\("",\I\J"~ Q~t~ STATE:
,
.. .~
5'11
,~
95tJ2.7 :5
JOB NUMBER
225 Fi fth Street
Springfield, Oregon 97477
PAl2::i 0'(::
TAX LOT: ,,[ 2.5';;> H'LeO
SUBDIVISION: ~/~t5 ~~
PHONE: '7 '-17-01'51
,...
)
O~G..r\~ ZIP: q7'-17~
..
DESCRIBE WORK: ~ r\n~O: ~rit li\-\ \_~n(\9_ _
NEW)( REMODEL (J ADDITION \bEMOLlSH, " OTHER
..........--..---------
~-
"-,
',-
'-
"',
'-...
CONTRACTOR'S NAME ADDRESS
GENERAL: ~)~~~~ r_o.,~~'''I..~--iCo~''S>J
PLUMBING: ,C....:S.'TO\'Y-. ?L~......ei~"
MECHANICAL: ~"/l<5 (;.44AA/~~
- I ' ..,..,..,
ELECTRICAL: j11 <:-I<.e~z.'c: ,""i"'<::':~
CONST.
CONTRACTOR /I
S,A""w MAS ,48Q.~
P,\qqL\
M\\o~
" '" Loffin
-',,--
EXPIRES PHONE
, , ~
5Z,39{p Z-~", 70~O;SI\
5.loqto ~'''~~J
lo-l)QS 31).28&""
() -/3 .q(o 7%.4OtR
QUAD AREA:cQQ1\Ju)
It OF BLDGS: ,
OCCY GROUP: r~D~ ~
, \
c;
It OF STORIES:
WATER HEATER:
- OFFICE USE -
\ \ \ \
It OF UNITS: \. '\
CONSTR. TYPE: \) J\.J
~ Gt..
G'?
LAND USE:
HEAT SOURCE:
RANGE:
FLOOD PLAIN: '\
ZONING CODE: lIJV
It OF BDRMS: _ ~
SECONDARY HEA; ~
SQUARE FOOTAGE:cQ \ ~
To request an Inspection, you must call 726-3769. This Is a 24 hour recording. AI/Inspections requested before 7:00 a,m, will be
made the same working day, Inspections requested after 7:00 a.m. wll/ be made the fol/owlng work day.
m Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/ Electrical/
Mechanical - Prior to cover.
rvl Footing - After trenches are
L-..fU excavated.
rYI Masonry - Steel location, bond
~ beams, grouting. '
r\7I Foundatlon - After forms are
L-.f.! erected but prior to concrete
placement.
o Underground Plumbing - Prior
, to filling trench.
, rYI Underlloor Plumbing/Mechanical
~ - Prior to insulation or decking,
IV! Post and Beam - Prior to floor
~ insulation or decking, , \
Cf1 ~~~~~~~~Ulatlon_=-_!:~~\t()' ~'\
1\71 Sanitary Sewer - Prior to filling \
Lp:J trench.
rVI Storm Sewer - Prior to filling
L.pJ trench.
IV1 Water Line - Prior to filling
~ trench.
rYl Rough Plumbing -:- Prior ,to.
~ cove~ ,..'
REQUIHED INSPECTIONS
I\rl Rough Mechanical - Prior to
~ cover.
I\,;:l Rough Electrical - Prior to
~ cove~ '
rvl Electrical Service - Must be
Lf'-1 approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing ,Insp.
~ Framing - Prior to cover,
IV1 Wall/Ceiling Insulation...., Prior to
Lp..J cover.
~ Drywall - Prior to taping. ,
D Wood Stovo - After Installation.
D Insert - After fireplace approval
and Installation of unit.
~
rv:l Curbcut & Approach - After
~ forms are erected bllt prior to
, placement of concrete.
~ Sidewalk & Driveway - After
r excavation Is complete, forms
and sub.base' material In place.
o Fence - When completed.
rx:l Street Trees - When all requl~ed
F trees are planted, ,
rY1 Final Plumbing - When all
T plumbing w<;)fl~ Is complete.
rVl Final Electrical - When all
I electrical work is complete.
IV1 Final Mechanical - When all
Lf'.l mechanical work is complete.
I'll Final Building - When all
~ required Inspections have been
approved and building is
completed.
D Other No . '~'l'\",l 'Occ"'~..~ ~ '
",~til iwrro.s+V~~...~
i~ o.cc..llpt b.j Pubh'(..
Wo~/cs '
MOBILE HOME INSPECTIONS
o Blocking and Set.Up - When all
blocklng,ls complete,
o 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.
o Final - After aI/ required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed,
" "
. . " ,~;~~ ~ .:: . " r,
"
I'
Lot Typ Setbacks IS THE PROPOSED WORK tN THE,
~ Accl .... HISTOI'lICAL DISTRICT, OR ON
Interior P.L. HSE GAR
I THE HISTORICAL REGISTER?
Corner N If yes, this application must be signed
Panhandle S I and approved by the Historical
Iw I Coordinator prior to permit issuance.
Cul-de-sac IE I
APPROVED:
BUILDING VALUE, PLAN CHECK
= VALUE AND BUILDING PERMIT
. -9- ~\ts~-e~~ This permit Is granted on the express condition that the said
I :"9~-"~-:, c..,," l. construction shall, in all respects, conform to the Ordinance
" \ ( 13L.\. ~ ~ '~dopted by the City of Springfield, including the
-- ___:.0.......:..:., - - -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.
~~,?~
3,/yi F
Receipt Number: J h <:tc;4
~~
Lot faces
Lot sq. fig.
Lot coverage
Topography
Total het4R1f'
~'._'
BUILD.ING' P.ERMIT
ITEM sa. FT.
X $/SO. FT.
-56 to
J ~:J>o
,
Main
/h5"'l
&)/7 r;.,
Garage
Carport
Total Value
- - ,----~~~
\t;(l/)~Ll, .'
" -~-~-~~~-:
~[.~-t~_~~/ r3Lt~
~~' _~JC.O 7 ,
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) . ~ '2'2.(o4!E. -$
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s)
~
1ka.~
NO
Sanitary Sewer
FT,
Water
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
\'=C~
\~,~
\ 1~. eo
State Surcharge
~.ro~~ ~
Total Charge
(C)
MECHANICAL PERMIT
<O,~
~.~
c;.~
\s. c:!?a
'S.~
r;.Q:Q
.l4~. ~
c.Jb
\t"I.-
~.~
SS .5.l.
Furnace
Exhaust Hood
Vent Fan
~
NO
Wood Stove/Insert/Fireplace Unit
Dryer Vent
~{,J~~ ~{~ ~~
Mechanical Permit
Issuance
State Surcharge
~.\~-\- 3~
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk SO fl
Curbcut ,!}."\ ft
l1.~
l~.~
Demolition
State Surcharge~
Ur~d~~~
\&.~
j Lrl- .
"~,,~.Ol.!
- -
-.,.---- --.... ._'
~~Qf ~e~
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and' E' Combined)
Plan Check Fee:
Date Paid:
~c\~ved By:
p~1;iewed By
3j~Tf
Systems Development Charge is due on all undeveloped
properties withIn the City limits which are being improved,
ADDITIONAL COMMENTS
c:A-+ T~ ~ I ~2.D (~.rsl,
,~f\l\Q ~,l"1\"tb} 0.
I -tl:t-l i. ~ ~ (tQL()na- )
StL~ bc,t.\e
,I~ (", l -J.~ - ~c.
1..~~_ ~ulil; h ~ ~
Sh8~h;or~ '
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certl fy 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 time, that each address is readable
from the street, that the permit card Is located at the front
of the prO~zhe approv,e d set of plans will remain
on the sltL'1 ti es dirlng construc:n.
Signature ' f~
Date :; -Zc..r-Cfr
VALIDATION:
RECEIPT NUMBER
/" 7"'2 ~
, ---
"3.-r;z '/. ~5 '
; _3:3LL[~a' -,
~~/r
'/
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
ATIACHMENT B1
vJB NO. q 50"2 (~
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COt.1PANY: C-H-RI,? .{ T,t..,rv\Y ~O&~~S
LOCATION: \ { 9 4- C A. ~'j2... l P-< &E: -pLA-(...€:.
DEVELOPMENT TYPE: L- D P-- - NE:..W SFf<..-
\ f 0 ?'2.-t? '2l - l\L.-O I
BUILDING SIZE:
1. ~TORM nRAINAGE
IMPERVIOUS SQ. FT.
!.-OT SIZE
SQ. Ft.
. '- ,,-
,X $0.209 PER SQ. FT. 0'Z:'2~
"Z~ -, ~
2. SANITARY SEWER-CITY
NO. OF PFU I S I tQ
(See Reverse)
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X $43.26 PER PFU
~'B~:Y
'--- ~
X I. 0 \ X $436. 19
X X $436.19
04-0 '?~)
'- ~
$
x X $436.19 $
SUBTOTAL (ADD ITEMS 1.2. & 3) $ l ~4\ '=>?
4. SANTTARY SEWFR-MWMC
NO. OF PFU'S \~ x $17.19 PER PFU + $10 MWMC ADMIN.FEE
(Use PFU Total From Item 2 Above)
$ '?\94;-
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL-MWMC SDC
SUBTOTAL (ADO ITEMS 1.2.3 & 4)
$ -e-
($ 3\941:. )
$'Z\~\~
5. ADMINISTATIVE FFFS
BASE CHARGE (SUBTOTAL ABOVE) X .05
c\O~~
-.......-. ------
~12uiy.'h.vt
SDC Coordinator
Date: ?/1L{- /~ t?
IQJBL SOC.
$ "'2.:2. b 9 !.2.
B2.SDC .
, FIXTURE UNIT. CAlCULP -'ON TABLE: Number of New Fixtu
(NOTE: For remoaCls;<'ca1culate only L ctEI additional fixtures)
NUMBER OF
FIXTURE TYPE NEW FIXTURES
Bathtub..~.................................................................. .
Drinking Fountain.... .............. .................. ....... ..........
Floor Drain.......... ........ ........ ........ ...... ..... .... ...............
Interceptors For Grease/OiI/Solids/Etc....... ..........
Interceptors For Sand/Auto Wash/Etc..................
Laundry Tub/CI<?thes~asher........,.. ..... :... .:.............
Clotheswasher - 3" Or More..........~...:...:..................
Mobile Home Park Trap {1 Per Trailer}..................
Receptor For Hefrigerator/Water Station/Etc........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Stall................ .............. ...................
Shower, Gang................................................... ~.:....
Sink: Bar, Commercial, Residential Kitchen..............~:........
Urinal, Stall/WaIL. ~:~:........................... .................. ....
Wash Basin/Lavatory" Single................... ........... ....
Toilet, Public Installation.............................. ..........
Toilet, Private... .......'.........................................:,..
Miscellaneous:
.. '
-i: ' :
z.
TOTAL FIXTURE UNITS
.
( Unit Equivalent =, Fixture Units ",'
UNIT
EQUIVALENT
2
1
2
3
'6
2
'9," . .
6
. 1
3
2
l/Head
2
2
1
6
4
FIXTURE "
UNITS
2.
-z.
'2.
'Z..
'2-
8
I po,
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table,
calculate credits separates.
Year
Annexed
Rate per $1,000
Assessed Value
Year
Annexed
1979 or before
1980
.1981
'1982'
1983
1984
,1985
$3.46
3.38
3.32
3.21
3.06
2.92
2.73
1985
1986
1987
1988
1989
1990
1991
1993
Credit for Parcel ?r land Only If Applicable
-e- X $ &> . 4;1..-
(Rate X Assessed Value)
X $' -
(Rate X Assessed Value)
,~ .~. ~
Improvement (if after annexation date)
Rate per $1,000
Assessed Value
$2.46
2.14
1.77
1.37
0.97
0.61
0.44
0.15
-e-
CREDIT TOTAL = $ ~
.;-.
/
;'
~,... Willamalane
't'l7' Pa,k & Rec,eat;on D;stdct
Job No. C ~~?~
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME: Jl\.n \ D "\ \~- QlS
ADDRESS: S l\ \4\ Wm
PHONE: ,<:\-, O\S
STATE: fJ(LZIP Q14-1S.
"'-
LqCATION OF IllROPOSED BUI~D~SITEn " D ()
, Street Address if Known: 11 Lf-. \. . t1lM.1 a...n L ,--"LX.. .
. ' , ~,
Platt Name: ~Q1. TaxLotNumber: no~\ \\1DL
1. DEVELOPMENT TYPE (Check appropriate dwelling(s>. SDC Calculations and dwelling type
defjnitions are on the hack.>,
A.' Sim~Je Familv - Detached
\
NO OF UNITS
(
Manufactured home not in a park $ ,J N'\ ~O,
X $400 PER UNIT _=, ~.
Single Family home
.
B. Sim!le Familv - Attached
NO OF UNITS
X $370 PER UNIT =
'$
. C Multi-Familv Aoartment
NO OF UNITS
X $777 PER UNIT =
$
D. Manufactured Home Park
NO OF UNITS
X $280 PER UNIT =
$
WPRD SDC
$.!M:) .CD
'fJ
$
$~-J09CJ
2. SDC CREDIT (If applicable) SaC-payer must furnish proof of WPRD Credit
approval. See sac Credit Worksheet. '
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced for Credit)
Community Services
,-.... _Ir__~_-L...._..J
Da~ I ~o/ I ~~7~
~J\