HomeMy WebLinkAboutPermit Building 1992-12-1
OWNER: ~--~~~,?;~.lf~/ ~
ADDRESS: ~_n'_~~/ ~~C=-~~/~
---'7l-:-;~~Z?r .-' ,-
DESCRIBE WORK:, /ttLy~L'i?rL ~",7.:/: /1'C-.J_
REMODEL ,___X<._ ADDITION
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK: "
. / '/ -cP -::<
ASSESSORS MAP, _,_,~__. __L
LOT: ________'
CITY:
NEW",
CONTRACTOR'S NAME
GENERAL:. &W"#e:?f.."-=>
f'LUMnING:
MECHANICAL:__,, "n_.' ,,_n____,
ELECTRICAL: -.Ok~-.-,-
QUAD AREA:
1/ OF BLOGS: ,
OCCY GROUP:
_ ;8-3-
I
1/ OF STORI ES:
WATER HEATER: ________________
SPRINGFIELD
BLOCK:
JOB NUMBER ~2./5' 2"7
225 Fifth Street
Springfield, Oregon 97477
--
TAX LOT:
SUBDIVISION:
PHONE:
79'/- V7_?c5
~~ ZIP: e9?C///
;7;; 2)V?c.P/f
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
i..xl Rough Electrical - Prior to
cover.
[:::.::J Electrical Service - Must be
approved to obtain permanent
electrical power,
D Fireplace - Prior to facing
materials and framing Insp,
[l] Framing - Prior to cover,
D Wail/Ceiling Insulation - Prior to
cover,
[Z] Drywall - Prior to taping,
D Wood Stove - After Installation,
D Insert - After fireplace approval
and Installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete,
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
D Fence - When completed.
Cl Street Trees - When ,all requlrea
- trees are planted.
ADDRESS
CONST.
CONTRACTOR 1/ EXPIRES
PHONE
FLOOD PLAIN: _
ZONING CODE:
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.
STATE:
DEMOLISH
OTHER
C] Temporary Electric
[' J Site Inspection - To be madu
- after excavation, but prior to
setting forms.
D
Underslab Plumbing! Electrical!
Mechanical - Prior to cover.
D Footing - After trenches are
excavated,
o
Masonry - Steel location, bond
beams, grouting,
II Foundation - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D
Underfloor Plumbing! Mechanical
- Prior to Insulation or decking,
D
Post and Beam - Prior to floor
Insulation or decking,
o Floor Insulation - Prior to
decking, _
D Sanitary Sewer - Prior to filling
trench,
r I Storm Sewer - Prior to filling
trench,
D Water Line - Prior to filling
trench.
IYI Rough Plumbing - Prior to
cover,
- OFFICE USE -
LAND USE: _______
II OF UNITS: _'__m'_______,_
~err
RANGE:
~ Final Plumbing - When all
plumbing work Is complete,
IZl Final Electrical - When all
electrical work is complete,
o Final Mechanical - When all
mechanical work is complete.
n7l Final Building - When all
)4-J required Inspections have been
approved and building is
completed,
o Other
MOBILE HOME INSPECTIONS
o Blocking and Set-Up - When all
blocking Is complete.
, ).
o Plumbing Connections - Wilen
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.
r:
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;: -' ~
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11"'1
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f,;1
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O'Flnal - After,all reqt,Jlred
.. .Inspecllons;'are,approved and
";'. 'is' porches;':skl'rtln'g,'. de'cks, and
venting have been Installed,
~ I;T~~~6:~~gl~~~I~~~~~~N ~~,E : ::~;'~lt~J,~~
, ,,' """,,,,, ", u', ~'''''ftW!j'~''''',l,' :,,;! ",t t, ';'?';"\W'~ E.
TH E\"l'!1lP~ICA.L ;,~,S<fl~:r~~~' ~~;.,~j~l
If yes, this apPlicati~'hmust be signed . ,~~~
".~ ::' ". t." ,.t ; '~I.-:t' ,'.~': ;~" i ': '. ',.~;,~';;
and 'approyeq; by' the ~istorlcal ";~
Coordinator'prior to permit issuance,' <~
I,-ot(ac~
;~;:~t~ ,,:,
,'Lo(coverage ,:,'
'~'~:,~..!:.?;;~g~~:~: :J~;,~~~:~.:-.\ ;:
To pog r?:p!1y :':,:'i-" .
.. ' 'I:j~' ~' .:: . ; .. '. , .
TotaL height '
Setbacks' , .
qii?li#r. ;~:fSEttdARiiACC,,',~i
;:/:rr":';"" .1
, Iw' I
~~~~
"
,,: t"~~!~i<!;:i,a~~~ .,< } \
> Panhandle
!;i"":~:'>;)" '
_ QU/~ge~sac
~ ~ :~-,
i.~ ?'~:'> ....
;: ..~'. .:........-;-_~ ;..;'.... (. ,~../",....1. ;..:.~~;fr..'f1,
'BlJltDJNG;P.ERMIJ: '
ITEM"~' ".,,"~ :;i~'::S&~'~T8::;"
Main
, VALUE
"," '';'
"
~ '
Garage
Carport
~/j)e-t'
Total Value
7C/~ "...
Building Permit Fee
State Surcllarge
~2.. 6"~
I.~
!' 'I. / -::J
Total Fee
(A)
SYSTEMS DEVELOF.UVIENTCHARGE (SDC)
, " "",'."(B)" "'~
PLUMBING'PERMIT'
ITEM
FEE
Fixtures
~
/~
Residen tial Bath(s)
NO
Sanitary Sewer
FT,
Water
FT,
Storm SeYJer
FT.
Mobile Hom'e
Plumbing Permit
~" a1Jf'
/.~p
:2.~
State Surcharge
Total Charge
(C)
MECHANICAL P,ERMIT
~I '. ' . ,.' :"
Furnace " '
Exhaust Hood
Vent Fan
NO
Wood Stove/lQsertlFireplace Unit
Dryer Vent
Mechanical Permit
Issuance
Sta'te Surcharge
.. "
Total Permit
~.:; "'" '<; . ~ t,~.~ '},~;:".
M ISC ELLAN EO U5'j PE RM rrs~~
. ,0.' ,.'~.' . ':'... ''''" '~.' "'( _{,';. .'. .;.
Mobil~ Home ' ' ~
. I' ~- . i
State 'Issuance
.-: \! ~.
State Surcharge
Sidewalk
ft
Curbcut
It
Demolition
State Surcharge, ' ,
~I'EZ~".. ,,',' ?JL;),
'. .." -,,'~:f.t~I~." ..:;,::;~_:",,~,:~_~;:;,.~.;~~~~.,:..~.~..~__~':;~::~J,>',: '
'Total Miscellaneous, Permits",!},,"; (E) i:' , . ' "
TOTAL AMO'Ut:n'DUE"(e~~IUding"'electrical) ~.t:J1
(A, B; C, 0, and E Combined)
APPROVED:
;'
BUILDING VALUE;'PLANCHECK
AND' BUILDING PERMIT,
,'., . - ."" ..... ., .;"
This permit is granted,on tile express condition tllat the said
construction shall, in ail 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 F~e: _;;:;./. /~
1'),. -1- 0~
(d1:J..<;'
~
Date Paid:
Receipt Number'
Received By;
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties within the City limils which are being improved.
ADDITIONAL COMMENTS
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 tile 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 tllat only contractors and employees who
are In compliance with ORS 70'1.055 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, tllat the permit card.ls located at the front
of tile p'roperty, and the approved set of plans will remain
on the site at all times durin;.fm~ti~n, ./
Slgnatu}1 /~/~J /Y&~~
Date (~/q?
VALIDATION:
RECEIPT NUMBER
bq~c:; "
\':).-1-0'";;)..
.c ~...,/ < 23.0'
~e&
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
JOB NO. qz,/S2.."
,
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: MIKE- GsA~fZ-E.T$~H
LOCATION: qt..{ 5 CelJ.{slJAJ IA L 'BJ-vp ( 7 - 6 '3 ' 'Z{o - ~ ~ - /Lf~o
DEVELOPMENT TYPE: LOIZ- - ~eMo/,)e..L.. ~ ADO $P-R-.
BUILDING SIZE:
1. STORM DRAINAGE
IMPERVIOUS SQ. FT. N~ 4&>t:Jeo
LOT SIZE
SQ. Ft.
X $0.192 PER SQ. FT.
c; -)
----- -----
2. SANITARY SEWER-CITY
NO. OF PFU'S
(See Reverse)
z
X $39.78 PER PFU
( 7'150
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
I X I. 0'0 S. X $401.05
GfO? ~?)
---- ~
X
X $401. 05
X $401. 05
$
$
X
--
$ J Ig.., ,"_2-
SUBTOTAL (ADD ITEMS 1,2, & 3) I ~
4. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
<C'Z~ '~
TOTAL-CITY SDC $ So<..'7~
5. $ANITARY SEWER-MWMC
NO. OF PFU'S x $13.62 PER PFU + $10 MWMC ADMIN. FEE $
(Use PFU Total From Item 2 Above)
---
0-, ~Ld
U Kip Burdick
SDC Coordinator
II /'1 /11-
I (
$ -
TOTAL-MWMC SDC~
~ ----
TOTAL SDC $ SOG:. ~
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
FIXTURE UNIT CALCULA1..JN TABLE: Number of New Fixtures X
For remodels, calculate only the NET additional fixtures)
t Equivalent == Fixture Units (NOTE:
-,
UNIT
EQUIVALENT
FIXTURE TYPE
NUMBER OF
NEW FIXTURES
Bathtu b.................................:....................................
D ri n ki ng Fou ntain.... ...............................................,.
Floor Drain......... ............... ......... ...... .............. ....... ...,
Interceptors For Grease/Oil/Solids/Etc.................
Interceptors For Sand/Auto Wash/Ete..................
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 jEtc.,
Shower, Single StalL........ ................ ........,., ...... ,....
S hower, Gang...........................................".............
Sink, Bar, CommerciaL.............................,........ ,..,
Urinal, Stall /Wall....:.... ........ ..............,...,. ................,.
Wash Basin/Lavatory, Single...............................,..
Water Closet, Public Installation.........................,...
Water Closet, Private.................... ..................",......
Miscellaneous:
2
1
2
3
6
2
6
6
1
3
2
1 jHead
2
2
1
6
4
I
TOTAL FIXTURE UNITS
FIXTURE
,UNITS
2.
z.
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
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
Credit for Parcel or Land Only If Applicable
Improvement (if after annexation date)
x $
(Rate X Assessed Value)
X $ ='
(Rate X Assessed Value)
CREDIT TOTAL = $
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
r
r.
t'
Residential...........,..,.,... ............,... .............. ...... 0.4
Commercial... ..... ... ,...... ...,... .......... ..., ............... 0.9
I ndustrial..............,..., ..,..... .... ............................ 0.45
Governmental.. .....,......."....., ..........,..........' ,..... 0.5
I'.
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
Ire