HomeMy WebLinkAboutPermit Building 1994-10-7
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
9'4//) Z-
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
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TAX LOr: ................~~<;7~
SUBDIVISION: \Let' -r. Q. 'i S ~ rc;.""\
4-0...J S~rO
PHONE: '"1-4 +- \ 10 SO
LOCATION OF PROPOSED WORK:
ASSESSORS MAP: /7 () .~
\S-} I b ~ Ii- -
1)200
A\)()
LOT:
BLOCK:
~ ~ \<:.-=- N L- ~. "S '" !'J D'-{
\ L.' \ L- C..e '" -\ ..e. If' '" ~ t(.\ '~\" J.
OWNER:
ADDRESS:
'S~ 12 D
CITY:
STATE' uf.L
ZIP: ~T~
AIYD\N~
t:=-CZ v t-J ' \
?O\ctt
DESCRIBE WORK:
NEW ~[ REMODEL
( ,
ADDITION
DEMOLISH
OTHER
CONST.
CONTRACTOR /I EXPIRES
\"2\'2_ C:e"'t'N\\J 15,,,,&
CONTAACTOA'YNAME '
GENERA' '~\.I 5'~L-f:' "j
PLUMBING:
MECHANICAl'
ELECTRICA' .
ADDRESS
'F~\C2~c.., A. ,C:::;:f\ ~':::>I../
I
PHONE
7-47:}-lb~U
- OFFICE USE -
LAND USE: \ \ \ \
CONSTR. TYPE: V AJ
QUAD AREA: 6)Q1\,)( 0
FLOOD PLAIN'
ZONING CODE: ~
/I OF BDRMS:
/I OF SLOGS:
OCCY GROUP:
/I OF STORIES:
WATER HEATER:
# OF UNITS:
kA
HEAT SOURCE:
RANGF'
SECONDARY HEAT:
SQUARE FOOTAGE:
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
o Temporary Electric
o Rough MechanIcal - Prior to
cover.
o Final Pllimblng - When all
plumbing work Is complete,
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o Rough Electrical - Prior to
cover.
o Final Electrical - When all
electrical work Is complete. C
o Undersl,ab Plumbing/Electrical!
Mechanical - Prior to cover.
o Final Mechanical - When all
mechanical Work Is complete.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
l'v1"'Footlng - After tr.enches are
~ excavated. . :
iXr.Flnal Building - When all
c1requlred Inspections have been
approved and building Is
completed.
o Fireplace - Prior to facing
materials and framing Insp.
o Masonry - Steel location, bond
beams, grouting.
~Framlng- Prior to cover.
i
D'walllC'elllng InsJlatlon - Prior to
cover.
o Foundation - Aft'er forms are
erected but prior to concrete
placement.
o Other
o Underground Plumbing - Prior
to filling trench.
o Drywall - Prior to taping,
MOBILE HOME INSPECTIONS
o Underrloor Plumbing/Mechanical
- PrIor to Insulation or decking.
o Wood Stove - After Installation.
o Post and Beam - Prior to floor
Insulation or decking.
o Blooklng and Set.Up - Whe[1 all
blocking Is complete.
O Insert - After flreplaoe approval
and Installation of unit.
o Floor Insulation - Prior to
decking.
o Plumbing Connections - When
home has been connected to '
wa.ter and sewer.
o Curbcut & Approaoh - After
forms are erected but prior to
placement of concrete.
o Sanitary Sewer - Prior to flfllng
trench.
DE,ectd-oal Connectron - When
blocking, set.up. and plul"Qblng
Insp'ectlons have been approved
and the' home Is connected to
the~erVlce panel.
o Sidewalk & Driveway - After
exoavatlon Is oomplete, forms
and sub-base materIal In place,
o Storm Sewer - Prior to filling
trench.
o Water LIne - Prior to filling
trench. ,
o Fence - When cOTPlete,d:
.,"\
\
O Street Trees - When '~II required,
trees are planted. '
. ;i.."!'.",'. .., ....
o Flnal'~.,,~fter all required' ",',
InspecttoDs are. approved and,
porches,skldJng, decks, and
venting have been Installed,
o Rough Plumbing - Prior to
cover.
Lot faces
Lot Type
Interior
Lot sq. ftg.
Lot coverage
Corner
Topography
Total ~elght
Panhandle
Cul-de-sac
BUILDING PERMIT
ITEM sa, FT.
;;. 'i':;\~.;\'
Setbacks '
HSE GAR ACC'
I
I P.L.
IN
Is
Iw
IE
Main
X $/SO. FT. = VALUE
/7.S-0
~ ,:8,
~~a ~.<<.~' . S-3-
(A) 1~_'11
SYSTEMS DEVELOPMENT CHARGE (SDC)~
-& ,,~'5 'R--'
(B) \t.--
Ga~age
Carport
.MtJ)lt'Y ~
Total Value
Building Permit Fee
State Surcharge
Total Fee
PLUMBING PERMIT
ITEM
.FIxtures
, ,: '
Resldentlai Bath(S)':';r:J~.',,;
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/Insert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuahce
State 'Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
SIdewalk
ft
Curbcut
ft
Demolition
7~~hb/G;v
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
"
/Cn90 ~ '
FEE
\
\
J/, Sf>
1-:: _2.+'
j THE PROPOSED WORK, tN 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.
;, /, ji,
Plan Check Fee: / .
Date Paid:
Receipt Number' -
A.cel'~~jW_ ~~/7'I
Plans Rev\.ewed By' - / DafJ ( ,
Systems Development Charge Is due on all undeveloped
properties within the City limits w~ich are being Improved.
ADDITIONAL COMMENTS
_~CC?y</,~/'. L~~,~Jt;LZ{I7JT
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J1~An-/ ;r-.,
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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
Z~1=:~~
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VALIDATION:
/ 4 t::}9 2..-
/d/7/Jd
( 1./-?1-cf,
AMOUNT RECEIVED "JC-..) ,
~-
, .
RECEIPT NUMBER
DATE PAID
RECEIVED BY
AnACHM~NT B1
,
JOB NO. '1t..f 11/ 2
, "'.,,'" '
CITY OF SPRINGFIELD SYSTEMS DEVELOPMl.,( CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: ::>Ptt-.J D'< ~ €::.~E:..t-..l c..
LOCATION: '\'2..\"Z.. rC.N..\~~II\-L ""&-VP .'
DEVELOPMENT TYPE: Lo~ -,~OD I "\lD"-\
\ 1t>~'2-~L-\ &..\ - \ \ 200
I
BUILDING S.rZE: '-\. Y- (~. ~
LOTSIZ(
SQ. Ft.
1. STORM DRAINAGE
"
" ?~
IMPERVIOUS SQ. FT..
2. SANITARY SB{FR-Crn
NO. OF I, PFU'S '
.. (See Reverse)
,
3. TRANSPORTATION ,
X $0.209' PER SQ. FT. $ '\'2...?~
X $43.26 PER PFU $
NO OF UNITS X TRIP RATE X COST PER TRIP
X
X
, ' X
X. $436.19
X $436.19
$,
$
$
SUBTOTAL (ADD ITEMS 1. 2, & 3) $
"
X $436.19
4. SANITARY SFWER-MWMC
NO. OF' PFU'S x $17.19 PER,PFU + $10' MWMC ADMIN.FEE $
(Use,PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE) $
.' . ,TOTAL -MWMC S.oc' '$
SUBTOTAL (ADD ITEMS 1.2:3 &: 4) $ \ 2 '?.!::-
5. ADMINISTATIVE,FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
$ Qf02-
v. ~~, ,-L~
~~y Hornig, P.E.
SDC Coordinator
'Date: '-.LLJ/7h./ '
( ( (
TOTAL SDC
$ 1'2~
B2 . SDC .
FIXTURE UNIT -CALCULATION TABLE: Number of New Fixt., ~'i X Unit Equivalent = Fixture Units
(NOTE: For remodels, calculate only NEI,additional fixtures)
, NUMBER OF
NEW FIXTURES
FIXTURE TYPE
Bathtub........... ...........................................................
Drinking Fountain. ............. ............. ..... .....................
Floor Drain............. ..... ....................... .......................
Interceptors For Grease/Oil/Solids/Etc. ....:. ..........
Interceptors For Sand/Aut? Wash/ftc.,.................
laundry 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 Stall..... .............. .,........... ..................
ShoWer, Gang..................................,.....;.................
Sink: Bar, Commercial, Residential Kitchen........................
Urinal, Stall/Wall... :....................:........... ......~.............
Wash Basin/lavatory, Single..................................
Toilet, Public Installation.... .....................................
Toilet, Private....................:...................................
Miscellaneous: ,TAI</I ro.e'.s $/-"1)::
,) I ;
, "'\ . I .f 1 ~ (
UNIT
EQUIV ALENT
2
1
.' 2
3
6
2
6
6
1
'.t 3
2
1/Head
2
2
1
6
4
..z
TOT ALFIXTURE UNITS =
FIXTURE
UNITS
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
1979 or before
1980
1981
1982
1983
1984
1985
$3.46
3.38
3.32
3.21
3.06
2.92
2.73
Credit for Parcel or land Only If Applicable
Improvement (if after annexation date)
',''1.
, ,
-<
I '
~ ;.
. I I'.
'f '.
'fear
Annexed
1985
1986
1987
1988
1989
1990
1991
1993
X $
(Rate X Assessed Value)
X $
(Rate X Assessed Value)
=
=
Rate per $1,000
Assessed Value
$2.46
2.14
1.77
1.37
0.97
0.61
0.44
0.15
CREDIT TOTAL = $