HomeMy WebLinkAboutPermit Building 1994-1-21
RESIDENTIAL f
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
Lfl r
SPRINGFIELD
~-
LOCATION OF PROPOSE.D.WOR~. Ci;?LJ (\{i <)' ~.~
'\r2n D'" ~1~
ASSESSORS MAP: .eX../< ()l /. .
LOT: '4c. ' " BLOCK: 4'-
OWNER:~V\ Oql.:'~1~
ADDRESS:' to q 7 0 /) '::>r'
- '5pJ-rA
~f=--(l-e~ .
CITY'
DESCRIBE WORK:
NEW ~, REMODEL
ADDITION
STATE:
fPt---
DEMOLISH
OTHER
CONST.
CONTRACTOR #
1flfLJ
CONTRACTOR'S NAME ADDRESS
GENERAL '\l<i-~'l~~ Kef{ ~q W13sY 1!k51'vl,l\
PLUMBING:~h f) 11 0 \",/1 LalltQ~ '
MECHANICAL:,{.(~.l:1: ../
ELECTRICAL: UZih lL.i U~/I/ : ..
QUAD AREA:
~~t:
- \
f\~'+ tV\
!J -.
f~
# OF BLDGS:
OCCY GROUP:
# OF STORIES:
WATER HEATER:
"- OFFICE USE -
LAND USE: \ \ I ,
# OF UNITS: ,
CONSTR. TYPE: -1/ A)
HEAT SOURCE: ,~
'~
RANGE:
'S'i'z:tc
JOB NUMBER
q L/{)OY3
225 Fifth Street
Springfield, Oregon 97477
TAX LOT:
oG4CYJ
(IILY(lJ)fllL-,tf--fI<,
. .
7lfj - ~3-70
SUBDIVISION:
PHONr=.
ZIP:
Q 7Lf 7R
, ,
EXPIRES f,
Z -f-:s-1'i
PHONE
~1S~41CD
FLOOD PLAIN:
ZONING CODE:~
# OF BDRMS: ' ,,' ~
--
SECONDARY HEAT:
SQUARE FOOTAGE: r{<~~
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.
~ Temporary Electric
...
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumbing/ ElectricalJ
Mechanical - Prior to cover.
~ Footing - After trenches are
excavated.
D' Masonry ,"'- Steel location, bond
beams, grouting.
[2g. Foundation - After forms are
, erected but prior to concrete
placement. .
o Underground Plumbing - Prior
to filling trench.
IX, I Underflbor Plumbing/Mechanical
~ ...,...,Prior to insulation or decking.
~. Post and Beam - Prior to floor
LA! insulation or decking.
f'Vl' Floor Insulation - Prior to
~decking.
cVl Sanitary Sewer - Prior to filli~g
~ trench.
I '-I1JStorm Sewer':"'" Prior to filling
~ trench.
r.Jl Water Line -, Prior to filling
-16..!. trench.
IVI Rough Plumbing, - Prior to
\....C!Y co v e r.
REQUIRED INSPECTIONS
rvl, Rough Mechanical - Prior to
~ cover.
f17l' Rough Electrical - Prior to
~ cover.
fYl Electrical Service- Must be
~ approved to obtain permanent
electrical power, '
D Fireplace - Prior to facing
, ' materials and framing Insp.
!:pi Framing, - Prior to cover.
I'5tl Wall/Ceiling Insulation - Prior to
~ cover.
~ Drywall - Prior to taping.
D Wood Stove - After I~stallation.
D Insert - After fireplace approval
and Installation of unit. ,
IVl Curbcut & Approach - After
~J forms are erected but prior to
placement of concrete.
~ '
Sidewalk & Driveway - After
excavation is complete, forms ,_
and sub-base material In place.
D Fence- - When completed.
D Street Trees --When all required
trees are planted.
[5{J
Final Plumbing - When all
plumbing work is complete,
iYl Final Electrical -When all
q eiectrical work is complete.
~ Final Mechanical - When all
~ mechanical work is complete.
Ul Final Building - When all .
JAI required inspections have been
approved and building is
completed.
D Other
MOBILE HOME INSPECTIONS
D Blocking and Set-Up - When all
blocking is complete.
D 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 required
inspections are approved and
porches, ski rti ng, decks, and
venting have been,installed,
Lot faces
Lot sq. ftg.
Lot coverage
Topography /'
Total height AC::S \
(C/tJ
i.' BUILDING PERMIT
SQ. FT.
I7CJS
1120 ?;
ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
Lot Type
.X Interior
Corner
Panhandle
X Cul-de-sac
X $/SQ. FT.
qo,,~
(Lf dO
(A)
Setbacks
I P.L. HSE GAR ACC
IN
Is
Iw
IE
VALUE
/00 I ~1-7 .()(}
'lID i 0fIidJo
4"50. '75
J)a..~
4M.lcff
SYSTEMS DEVELOPMENT CHARGE (SDC) tfg
(B) * "'2-2Cep(2j
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
. Sanitary Sewer
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
'-~
FT.
FT. -
FT.
(C)
Dryer Vent
Wood Stove/Insert/Fireplace Unit
NO
4-
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLAN.EOUS PERMITS
Mobile Home
State Issuance
State Su rcharge
Sidewalk -4 \
ft
Curbcut
3~ ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
FEE
\q~~
\ ~2 .9)
q.lP3
~oQ,F:)
, cO
lo. .~
A-gJ
\'r;i:)
l~, .
=-
3O-J
~5.5D
J1)~
1,~B
.3{ J) /78
J lo .LCS
\~ 9()
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
~q
OJ''
.
rHE 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: 2-, Q'7 I t::; t.J .
-L~t.j
Receipt Number: 1l"37L/
(li~
Date Paid:
Received 'By:
plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
propertieswithin the City limits which are being improved.
ADDITIONAL COMMENTS
~~mo /AS il.Q S1 10 .~ ~
, - - .. ~ (j - ~ ~\OJG )
\ J-+ \ : ,;Il CJLo() % -
\~nQ;( rn\O.J', \C\lLO
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 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.
s;gnat"~~ ~d
Date .~/ It:.f
VALIDATION: ~ L /lll
RECEIPT NUMBER "J 0)
DATE PAID { - ~ \-CMr
AMOUNT RECEIVE~~3 5C1~ ,2~
RECEIVED BY \[l}-/
v .-
" ...
Permit No: CJ4C()t~
Address: Ef/\ (0)N'OoLu
Issued by:C7'FX).,J Date: If) (Cf1
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment is required for residential building, electrical, mechanical, and plumbing
permits, Licensed Architect and Engineer applicants, exempt from registration.
under ORS 701.010(7), need not submit this statement. This statement will be
fi led with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1. .1 1.1 lawn, reside in, or will reside in the completed structure.
2. I I understand that I must register as a construction contractor if the structure is sold
, " ;j or offered for sale before MP~n, < comPlet\~.
3. A. 1 '\L2J MY. general contractor ;, -, ~ .l.l~. '\"~.x-r-"
Contractor registration number f7 , 1-it
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3. B.I
I I will be my own general contractor.
If J hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If' change my mind and do 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.
~ L-f)/v i~~1J
~~~;ture <eft Perrtllt Applicant
1-2/- 94
Date
. CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COpy TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
.... ", .::,.
.
INFORMATION NOTICE TO PROPERTY. OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: Tt1is'll)formatjon Notice. to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5)", .
passed by the 1989 Oregon Legislature. , ' .
. '" " . .'. ::;" , '. . 1'.'''','' '. .
If you are acting as your own contractor to construct.a new home or make a substantial, improvement to an
existing structur~, Y9lJ.. G~n;prevent many problems by: being. aware of the following responsibilities af)d areas
of concern. ..; -- " . -, --, , " ' .
EMPLOYER RESPONSIB'ILlTIES:
,
~ . --! .'
If you hire person~ ~ot registered with the Construction Contractors Board to do labor in constructing or assisting
in the constrl!cti-on;or irhpro-verrient qf a residerltic;il stru<;ture,' you. witl, in mos!Jnstances, be ruled to be an
"employer" clri,d t'~~p'eopl,!'~ you hire"~iII.be'~empl;Qye~s;;. A~,the employer! you_must ~~m?ly with the following:
Oregon's Wit,hholding T~x Law: As an employer, you must ~it8h'0Idin'~ome taxes from' employee wages at
the time employees are paid. ,Yqu iNilLbe.liable for the tax payments even if you dqn:t actualJy withhold the
tax from your employees. For more information, call the Oregon Department qf.Revenue 'at 378-3390.
. ". . . '. I.
Unemployment Insurance Tax: As an employer, you are required tO'pay a tax for u.nemployment in'surance
purposes on the wages of all e'TIploye~s: For rlJoXe information, call the Oregon E.mployment Division DHR
at 378-3224.
r:;' ::.-.,..,., \
Workers' Compensation Insurance: As an employer; you are-sobject'tO' the Oregon Workers' Compensation
Law, and must obtain workers' compensation insyrance fQr your employees. If you fail to obtain workers'
compensation insurance; you may' be subject to,penalties and will be li'able fo'r.all claim costs if one of your
employees is injured on the job. For mo~~ information, call the Workers' Compe~sati()'~ Division DIF at 373-7434.
. "
. -- 1.
U.S. Internal Revenl,J~ Service: As an. e!)1ployer, you JTIustwithhold fe..deral incom~ tax from employees' wages.
You will b'e liable for'the tax PCiyriient eVen if you didn:t,adoallywithhold the tax. ,For more information, call
. (. . -f.'-'"....l ... "
the Internal Revenue Service at 221-3960. ,~.'
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Gomplianee: 'As the per:mitholder forthis"project, you are responsible for resolving any failure to meet
code requirements,.that may be'brought to -your attention through inspections.
Liability anCl Propert~,"Oamage Insurance: Contact y6ur' insurance agent to see ifyol,lhave adequate insurance
coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punc-
tures, fire, or work that must ,be re-done.
. : ""1\ ....... ,., . e-.,; ~ 'i ..... -:. ... .. .
Time' to Supervise Employees: Make sure you~ have' sufficient time to supervise your employees-.
.. -.,
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work
. of rough-in and finish trades, .and to notify building officials at the appropriate times so they can perform
the required inspectioris.. . - , ' , " ". ,':. , " ,..,..' .
- ..' , ' . . . ~ .' ..
If you have additional questions, write to:
Construction Contractors Board
700 Summer 81. NE, Suite 300
Salem,'-oR .97310-0151 ' , ,'-
,Phone 503-378-4621
,"
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" "0244J -10/24"/89"
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,.
JOB NO. q t..{ 00 t..f?
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: :ro\-\- f-.t Oe:.- L r::.51b"i
LOCATION: 58'-1- CA-S CAD IS / ~ () "2-02 '2.-7.. - CJ (p Lf OD
DEVELOPMENT TYPE: Lp/Z.. ~ New SrI!-
BUILDING SIZE: LOT S~ZE .SQ. Ft.
l. STORM DRAINAGE
IMPERVIOUS SQ. FT. 'Z-?1?~ X"$0.203 PER SQ. FT. (471 :;;-y
'-- ~"
2. SANITARY SEWER-CITY
NO. OF PFU'S 1.-'? X $42.08 PER PFU ~(Pl ii)
(See Reverse) '- ~
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X
4. SANITARY SEWER-MWMC
NO. OF PFU'S "2.'? x $15.125 PER PFU + $10 MWMC ADM FEE $ "?S7'6]
(Use PFU Total From Item 2 Above) .
X $424.31
E~8 5~
$
$
/
X I.OJ X $424.31
X X $424.31
SUBTOTAL
$ 7 c/I-!i
TOTAL-MWMC SDC ~~( ,~~ ~
~ ~ -z~
(ADO ITEMS 1,2,3 & 4) $ ~ ~~ ~ ~\Co\ :---
MWMCCREDIT IF APPLICABLE (SEE REVERSE)
5. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
l~ ~~ l /\~ /qt.f
--(f Kip Burdick I I
SDC Coordinator
o O~O~
'-. ~
TOTAL SDC $ 'ZZ<o~"2.-1-
FIXTURE:UNIT,CALCULA.... .ON TABLE: Number of New Fixtures) ,it Equivalent = Fixture Units (~OTE:
For remodels, calcul~te only the NET additional fixtures)
Bathtub,._........ ...............,.,.,..."........,.,.,...,.....". ,....,...
Drinking Fountain'........'.'.'..'....'''.'.'...'....'........'.'.
Floor Drain.............. ....,.......,.......,...,........,..........,.....
Interceptors For Grease/Oil/Sollds/Etc............,....
Interceptors For Sand/Auto Wash/Etc..................
Laundry Tub /Clotheswasher..... ,.......... ...... ......... ....
C1otheswa~her - 3 Or More_...................................-
Mobile Home Park Trap (1 Per Trailer)............._....
Receptor F9r Refrigerator fWater Station/Etc,.......
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single .Stall................ ...-." ........,. ........... .....
Shower, Gang.. ................ -.. ............... ,...............:.....
Sink, Bar, COmmerciaL_......._......... .......... ...... .........
Urinal, Stall fWall.. .........,.........................,......,......,...
Wash Bas!nfLavatQry, Single..................................
Water Closet, Public Installation....,....,...............,...
Water Closet, Private......._............ .......... ..... ...... ......
Miscellaneous:
FIXTURE TYPE
NUMBER OF
NEW FIXTURES
/
.' ,f
I
(
'2,
~
TOTAL FIXTURE UNITS
UNIT FIXTURE
EOUIVALENT UNITS
2 L..-
1
2
3
6
2 ~
6
6'
1
3
2 'Z
1/Head
2 "2..
2
1 ?
6
4 /2
Z~
Based on assessed value, If improvements occurred after annexation date in table,
Year
Annexed
Rate per $1,000
Assessed Value
Year '
Annexed
1979 or before
1980
1981
1982
1983
1984
-1985
$3.21
3.13
3.08
2.96
2.82
2.68
2.51
1986
1987
1988
1989
1990
1991
1992
. .
'-:.
~.z../ XS'2-f."IlP
(Rate X Assessed Value)
X $
(Rate X Assessed Value)
CREDIT TOTAL
, ..
Credit for Parcel or Land Only If Applicable
.J: 'J:.
I~provement (rt after annexation date)
Rate per $1,000
Assessed Value
$ 2.24
1.93
1.57
1.18
, 0.79
0.44
0.28
I'
I'
I
CREDIT CALCULATION TABLE:
calculate credits separates.
I
I
--, 0 4.!
=
= $ 10 &/-1
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
R esid entia!..... ................ .....,.~....... ..:. ......... ..,.... 0.4
Commercial...................................................... 0.9
I nd ustrial............................ ................ ............... 0.45
Governmental... ................. .......... ....... ...... ........ 0.5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
f\'
. ~~ }!i!I'!m!!~!!~
Job NO.'~
PHONE: r Jf.-R~
. STATE:oc'ZIP cnttj .
LOCATION OF PROPOSED BUILDI~~.r~
Street Address if Known: \..~\
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the back.}
Manufactured home not in a park
$ 'L'ro~
X $400 PER UNIT =
X $370 PER UNIT =
$
X $277 PER UNIT =
$
X $280 PER UNIT =
$
$1fO)~
$ j2f ~
, CO
$ 4fy). .
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet.
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced for Credit)
\ ~ffiL) )
Community SeiViCes Divisftv .
City of Springfield
or
/'
/ /dl/q1
Date