HomeMy WebLinkAboutPermit Building 1991-10-8
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OWNER: k"/Lr6~ ~ ~~.
ADD'RESS: ~~G .
CITY: ,5 /~L--~.
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DESCRIBE WORK: ..4~ ~;)IJ" ..'" r:;;:;-
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:
LOT:
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SPRINGFIELD
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JOB NUMBER
225 Fifth Street
Springfield, Oregon 9]-477
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TAX LOT: it:) y y< "9"
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BLOCK: .
SUBDIVISION:
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PHONE: -V ~ ?&./L-~4 7~
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STATE:
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ZIP:
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OTHER
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NEW
REMODEL
ADDITION Y
DEMOLISH
QUAD AREA: .~~
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# OF BLDGS:
OCCY GROUP:
# OF STORIES:
WATER HEATER'
ADDRESS
CONST.
CONTRACTOR #
EXPIRES
'PHONE
- OFFICE USE -
LAND USE: \ \_ \ \
# OF UNITS: \ /' 1\ I
CONSTR. TYPE:----Y-.J-V
HEAT SOURCE:
FLOOD PLAIN: .
ZONING CODE: ~
# OF BDRMS:
SECONDARY HEAT: -
SQUARE FOOTAGE: ,,~rtJr )
RANGE:
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
D Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
I\7l Footing - After trenches are
~ excavated.
D Masonry - Steel location, bond
beams, grouting.
rl7I Foundation - After forms are
l,4.J erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
D Underfloor Plumbing/Mechanical
. - Prior to insulation or decking.
o Post and Beam - Prior to floor
insulation or decking.
o Floor Insulation - Prior to
decki ng.
D Sanitary Sewer - Prior to filling
trench.
m Storm Sewer - Prior to filling
trench.
o Water Line - Prior to filling
trench.
o Rough Plumbing - Prior to
cover.
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REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
o Final Plumbing - When all
plumbing work is complete.
I\7J Rough Electrical - Prior to
~ cover.
~ Final Electrical - When all
electrical work is complete.
WI Electrical Service - Must be
~ approved to obtain permanent
electrical power.
D Final Mechanical - When all
mechanical work is complete.
o Fireplace - Prior to facing
materials and framing Insp.
[X] Final Building - When all
required inspections have been
approved and building is
completed.
IZl Framing - Prior to cover.
o Other
~
o Wall/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping.
MOBILE HOME INSPECTIONS,
o Wood Stove - After installation.
o Insert - After fireplace approval
and installation of unit.
o Blocking and Set-Up - When all
blocking is complete.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Plumbing Connections - When
home has been connected to
water and sewer.
.0 Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
o Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
o Fence - When completed.
o Street Trees -Wh'en all requi'red
trees are planted.
o Final - After all required
inspections are approved and
. porches, skirting, decks, and
v~nting have been in.stalled.
Lot Type e Setbacks
I P.L. , HSE'GAR'ACCI
Interior
IN I
Corner
Is I
Panhandle
Iw I
Cul-de-sac
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Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
BUILDING PERMIT
ITEM . SQ. FT. .
X $/SQ, FT. =
VALUE
Main
Garage
5," 2-....
-L!I./l>
. .
7~':1.~
Carport
Total Value
7~~~
t;;g50
A~,,'/3
71: 9~
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SD~
(B) ~ (o1~
PLUMBING PERMIT
ITEM
FEE
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/Insert/ Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Su rcharge
I
-.
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical) /79: -"'5'
(A, B, C, 0, and E Combined)
.
6> 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: ~~ 5:3
Date Paid: ?-/7-~ /
Receipt Number: ;Z/~ -'?
Received By' %"-~ - ,
~Ar ~ _~.~.--?
~~ RevieweCfBy 7
. /C:::> -g..q /'
Date
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
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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 pertai ni ng to the work descri bed
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 locate.d at the front
of the property, and the approved set of plans will remain
on the site at all times during construction.
Signature ~2(~
Date
I (J- / I-Cj /
VALIDATION:
RECEIPT NUMBER -:z./?~ C>
(ct;J7/-~ /
AMOUNT RECEIVED I?? .;:>"5
RECEIVED BY 4~~ ~<=-
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,
DATE PAID
........
JOB NO. ct \\ 0'10
CITY O~SPRINGFIELD SYSTEMS DEVEL~ENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL) .
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NA~lE OR COMPANY: \1\(.. -r6~ CoOK-
LOCATION: y.y.,'2- \)A\SY
\"1 0 7- ~ 7- ~y. -: 04 4 ~ ~
DEVELOPMENT TYPE: L DR ,- ADD. G/ld2_A&E.
BUILDING SIZE:
1. STORM DRAINAGE
I~lPERVIOUS SQ. FT. SS'1.. X SO.186 PER SQ. FT. $ \C2'i1
(See Reverse For Runoff Coefficients If Actual Imperv. Area Is Unknown)
I
'2-? .t.. '2- '-t
LOT SIZE
SQ. Ft.
2. SANITARY SEWER-CITY
NO. OF PFU'S --- X $38.55 PER PFU
(See Reverse To Determine Total PFU'S)
$
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X
X
- . X $388.61
X $388.61
$
$
$ -
& 3) $ t6-z.. <.:..J.
-
-
X X $388.61
(See Attachment C To Determine Trip Rates)
. SUBTOTAL (ADD ITEMS 1,2,
~
4. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
$ S~
TOTAL-CITY SDC S \0. ~
5. SANITARY SEWER-MWMC
tWo OF PFU'S
x $13.25 PER PFU + S10 MWMC ADMIN. FEE S
~
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
'~'~~LJl
t -0 Kip Burdick
SDC Coordinator
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$
TOTAL-MWMC SDC $ -
TOTAL SDC $ 1 01 ~
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