HomeMy WebLinkAboutPermit Building 1991-9-30
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CITY: "'S~'K\ \\)<.;~ \~ \..\)
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759 '
LOCATION OF PROPOSED WORK:
ASSESSORS MAP-
LOT:
OWNER:
DESCRIBE WOR""
NEW ~ REMODEL
CONTRACTOR'S NAME
OWY\.e..-V-
GENERAL-
PLUMBING'
MECHANICAL'
ELECTRICAL -
J\J/A
QUAD AREA: \ R ~ '1 ~l
\
~.
. OF BLDGS'
OCCY GROUP:
. OF STORIES:
WATER HEATER-
.
SPRINGFIELD
e_
JOB NUMBER
q//OSL-
BLOCK'
STAT"-
O~l:::.bct\1
225 Fifth Street
'Springfield, Oregon 97477
SUBDIVISION'
PHONE: 74-1,,:>1:,,1 -,4{,-R1<\
ZIP'
q14-11
~l"I~c:.e:
\
~LJ I' L~\ '" 0
OTHER
ADDITION
DEMOLISH
ADDRESS
CON ST.
CONTRACTOR'
PHONE
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
o .Rough Electrical - Prior to
cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
[E] Framing - Prior to cover.
o Wall/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping,
D Wood Stove - After Installation.
o 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 ~ub.base material in place.
o Fence - When completed.
o Street Trees - Whe-,; all requlrea
trees are planted. "". ~
EXPIRES
FLOOD PLAIN: ~ .
ZONING CODE: ill\~
. OF BDRMS'
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.
.":
J
I
o Temporary Electric
D Site. Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
[Xl Footing - After trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting.
[L] Foundation - After forms are
erected but prior to concrete
placement..
o Underground Plumbing - Prior
to filling trench.
o Underfloor Plumbing/Mechanical
- Prior to Insulation or decking.
o Post and Beam - Prior to floor
Insulation or decking.
o FI.oor Insulation - ~rlor to
decking,
D Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench.
o Water Line - Prior to filling
trench.
o Rough Plumbing - Prior to
cover.
- OFFICE USE -
\\ \ \
LAND USE:
. OF UNITS:
CONSTR, TYPE:
HEAT SOURCE:
\/ f\}
RANGF-
D Final Plumbing - When all
plumbing work Is complete.
D Final Electrical - When all
electrical work Is complete.
D Final Mechanical - When at!
mechanical work Is complete.
[XI Final Building - When all
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 - 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 all required
Inspections are approved and
. -., porches, skirting, decks, and
venting have been Installed.
Lot faces ~ Lot Type-
Lot sq, ftg, L Interior
Lot coverage Corner
Topography Panhandle
Total height /L Cul-de-sac
BUILDING PERMIT
ITEM SO. FT. X $/SO, FT
Main
Garage
Carport
~1Ml'P
\ "J.,Lj 4
JL..f./D
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
I P,L,
IN
S
W
IE
VALUE
J<,( ,0, ~i1LJO
a</../~
6.77
L'/J . 27
SYSTEMS DEVELOPMENT CHARGE (SDC)"ve,
~ '-t-~""--
(B) 7-4>'1--
PLUMBING PERMIT
ITEM
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
N'
Wood Stovellnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
Total MIscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A. B. C, 0, and E Combined)
FEE
41~~_ U
Setbacks
HSEIGAR
~s THE PROPOSED WORK IN THE
HISTORICAL DISTRICT. OR ON 1'VuJ
THE HISTORICAL REGISTER?
ACC I
I
1------
I
I
/~/
6
...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 az provisions of said ordinances.
Plan Check Fee: QI..:.!:/ 2>
q.c} ,Cj I
Receipt Number' ~ I d. l./3
Received By: ~~
~ 7"
~,- .~......,
- s Reviewed By /... ,
Date Paid:
~?~~
Date
Systems Development Charge is due on all undeveloped
properties within the City limits 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 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 CRS 701.055 will be used on this
project,
I further agree to ensurll tt]at all req_uired 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.
Signature C>,.., C) \'\ ^ 0' 0 0 nO
I \ ^ U ~ -
Date q q 'lJ4 I
. f 1 I -,
VALIDATION: 1./\ { J'--""
RECEIPT NUMBER AJ,r-tl (l )
DATE PAIr> <J\-\..V' C{ I
AMOUNT RECEIVF.n,/ ~~.~ l
RECEIVED BY ~ ~ -
A
I~
)
. . JOB NO. ("1'\\oS-l
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: -:Se:.~,< \2..E:.E::.D
lOCATION: en 'FA\~VIE.W 1;:>Fl.
l'1o',,:>-z.,4'2. - OC'lot
DEVELOPMENT TYPE: LD~ - At:>PlIlb!<.\- S-ro'iLAGE B,\...-O&
BUILDING SIZE:
I. STORM DRAINAGE
IMPERVIOUS SQ. FT. l~~ X 50.186 PER SQ. FT.
(See Reverse For Runoff Coefficients If Actual Imperv. Area
-z.~ ~ ,-\-<6
LOT SIZE
SQ. F t.
$. 2..<.fq~
I s Un knO\~n)
2. SANITARY SEWER-CITY
NO. OF PFU'S {) X $38.55 PER PFU
(See Reverse To Determine Total PFU'S)
s -tr-
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
o
X
X
X $388.61
X $388.61
s ----€r
s
-
X X $388.61
(See Attachment C To Determine Trip Rates)
SUBTOTAL (ADD ITEMS
S
<1'i!.
1,2, & 3) S '2.,-\-"1 -
d ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
S \'2-~
TOTAL-CITY SDC S 'Uoz. ~
5. SANITARY SEWER-MWMC
NO. OF PFU'S
-cr-
x $13.25 PER PFU + S10 M\-!I'!C ADI-HN. FEE S .e-
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
1~'~Lr.-L..
----0 Kip Burdick
SOC Coordinator
"'t - ,q -'11
S
TOTAL-MWMC SDC S ~
TOTAL SDC L"Z.G,Z. y.'ii