HomeMy WebLinkAboutPermit Building 1994-9-2
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
.
LOCATION OF PROPOSED WORK: ~~ / ~ ~ -=:
\ 'I (Y3ri. ~L\.?1
ASSESSORS M~t
LOT' ~(-)....
.::::
,"!
BLOCI<'
OWNER: 7='4-'/ t?/ ~OrC .z::>~c:::;
ADDRESS:~P:,P>'\~~ f rm j )
CITy:~J\l ^Df\'oON~ .
DESCRIBE WORK: 7lq./~ .
NEW X REMODEL ADDITION
CONTRACTOR'S NAME
GENERAL' ~C6r- ~..r/O';>~
PLUMBING: ~--::~
MECHANICAl . 'P~r
ELECTRICAL: -p~V~/G l!:<-/',
QUAD AREA: ~~ ll)_
. OF BLDGS'
Oc5CY GROUP: . ~ M
.Q
WATER HEATER: L--
. OF STORIES:
-'-"
o Temporary Electric
O Site Inspection - To be made
after excavation, but prior to
setting forms.
O Underslab Plumblng/Etectrlcal/
Mechanical - Prior to cover.
~ootlng - After trenches are
~ ~xcavated.
o Masonry - Steel location, bond
.beams. grouting.
~Foundatlon - After forms are
~ ~rected.but- prior to'concrete
praceme~t.
o Underground Plumbing - Prior
to filling trench.
~nderfloor Plumbing/Mechanical
a :'.prlor to Insulation Or decking.
~ Post and Beam - Prior to floor
~ Insulation or decking.
m Floor Insulation - Prior to
?-5 decking.
,..L; Sanitary Sewer - Prior to filling
~ trench.
~ Storm Sewer - Prior to filling
~ rench. .
Water Line - Prior to filling
trench.
Rough Plumbing - Prior to
cover.
~ Qj \:::Tn1lil. PHONE:
STATE: . (i1\. Q ~r"
DEMOLISH
OTHER
~r::1t;;:)C'::)r:7':":"
L~.\, .'
~f. --::~'1o
.
JOB NUMBER
..
I
<9 Y //9~
225 Fifth Street
Springfield, Oregon 97477
C'-?V.e:-~C~A'~
fJI/2:\ c> F:
TAX LOT:
SUBDIVISION:
/ pes-;Z:>
< ~~. I o~Dd---J
ZIP:
411] K"
CONST.
ADDRESS'.... ~,~gOR · EXPIRES PHONE
~_~~.,.?~-~? ,- 6"'1/':7{-/ ?-~ "3~;,,-
- . ,
- OFFIC},. U}!;, -
LAND USE: \\ rl-U
. OF UNITS: - ~
CONSTR.'TYPE: ~rJ
HEAT SOURCE: JC:;-..l:X::7 ~L
RANGE: _7 /
REQUIRED INSPECTIONS
r)(f R~ugh Mechanical"":' Prior to
~cover.
lV"i Rough. Electrical - Prior to
~ cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Flreplece - Prior to facing
7.meterlals and framing Insp.
a Framing - Prlor:to cover.
i
}".L, Wail/Ceiling Insulation _ Prior to
~ cover.'
JDryWall - prl.or to taping.
~ I ,.
o Wood Stove - Alter Installation.
o Insert - After fireplace approval
and Installation 01 unit.
~ Curbcut & Ap.proach - After
9 forms are erecteC;1 but prior to
~Placemont of concrete.
Sidewalk & Driveway - After
excavation Is complete. forms
and'sub-base ma'terlal In place.
o Fen~e - When completed.
O:Street Trees - When all required
trees are planted.
FLOOD PLAIN'
M Final Plumbing - When all
~plumblng wc;>rk Is camplet.c.
WFlnal ElectrIcal - When all
~electrlcal work Is complete.
Final Mechanical - When all
mechanical work Is complete.
Final Building - When all
qui red 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.
'-...
ZONING CODE: LUlU
. OF BDRMS,~+3
SECONDARY ~E~T: 0
SQUARE FO..P T~Gdlo(lQ '\
r I.}Il'f_?f l..1LiiZ:J-
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. ~III be made the following work day.
~...-
Lot faces
L~t '~yp.
~ Interior
Corner
Lot sq. ftg.
Lot coverage
Topography.
Total height ~ ' .
Panhandle
Cul.de'sac
ITEM
Main
Garage
Carport
Total Value
Building Permi t Fee
State Surcharge
Total Fee
(A)
. ';"t" " Setbacks.
. . ".. c: '."'" '. .;"'~.ii'L''''' ....." .
:'~;'" ',~ ::1 '; .,'~'~' Ii :r 'J l;:"v ?!:rt.;Lt,~ f/.
:;~:\~ \ .......~ . "~', ;.,:J;1;''''I', ;.
\ '
HSE GAR ACe' I
I
.,1
I
I
h~L.
IN
S
W
IE
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
$ 3-f'i'!. 3'i'
BUILDING PERMIT
~ ~l~:ft
PLUMBING PERMIT
ITEM FEE
Fixtures - &lxiJ
I N' ):J'j,Ci
R.esldentlal Bath(s)
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 StovellnsertlFlreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State surch?jl'l
Sidewalk" l- 0 II
Curbcut 3Le II
Demolition
",,\JRf\~( J(OH)
Total Miscellaneous Permits
(E)
TOTAL AMOUNT DUE (excluding electrical)
(A. B, C. D. and E Combined)
/~AO.d)
dJ.S.(d)
:::A 0.4C
q.UU
t r OU .
{ri. .
In.aJ
({)fLOG
/O,O()
~
\'8. .
\~4L)
Z\DW-
"S THE PROPOSED WO~K IN THE. .
...HISTOI;IICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
'j
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:. '. .,
"
Date Paid:
Receipt Number:
~ elved ~/t~m.~yt ire
PI s Flev e~e~ ~y- \
~'3\A1
Date ~
Systems Development Charge Is due on all undeveloped
properties within the Clly limits which are being Improved.
ADDITIONAL COMMENTS
,'7f!rA'/ ~~
~.;o~/~ c; -':::. rt..~,/.....:-
~~ A- ~/7:'5 ~~
,~'a.T?t~{(~(~u.E,
, .Qli Jll)DI f1 0 ,~l run nO V(' '"
\ ~-\- T: \ \ ~rx) .
lv~J\o~t~"). \C\\d8
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 Ordlnanc~s 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 Curtner agree to ensure that all required Inspections are
requested at the proper tlme,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 const<uctlon.
" .
. 51 nature P__"/39~..&.
- '. ./
9- A -9~
Date
VALIDATION: \L1l
RECEIPT NUMBE" -:\
y.
/J
r
.B NO. ~//-1
CITY OF SPRINGFIELD SYSTEMS. DEVELOPMENT CHARGE )
WORKSHEET .
(COMMERCIAL & RESIDENTIAL)
.
ATTACHMENT Bl
NAME OR COMPANY: fJ A/okl A'M
LOCATION';z. -:1o;j~ tj~~/~
DEVELOPMENT TYPF' ~
,
BUILDING SIZE: lOT SIZF ~Q. Ft.
1. STORM DRAINAGE
IMPERVIOUS SQ. FT. 25'(., C,
2. S8HIIARY SFWFR-CITY
NO. OF PFU'S 32.
(See Reverse)
3. TRANSPORTATTON
X $0.209 PER SQ. FT. $ 53(,...2'1'
X $43.26 PER PFU $ /321.52
.NO OF UNITS X TRIP RATE X COST PER TRIP
.J.. X /,01 X $436.19 $' 'if !i' /,/ tJ
X
X
X $436.19
X $436.19
$
$
SUBTOTAL (ADD ITEMS 1. 2. & 3) $.z. '8 0/. ;t z
4. S8HIIARY SFWFR-MWMG
NO. OF PFU'S ~2 x $17.19 PER PFU + $10 MWMC ADMIN.FEE $ S"'O.d~
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVE.RSE) $ 4r'}.~S-
-.. . IQIAI -MWMC SQC $ St'!.""
SUBTOTAL (ADD ITEMS 1.2.3 & 4) $ 332/.32.
5: ,AnMTNTSTATTVF FFFS
BASE ~GE (SUBTOTAlABOVE) X .05
~/I~. Date:
/"Hary\~ornig. Pl)
/" SDC C~ordinator .
$ /~~.();t
?-31-r~
IQIAf snr.
$ 3181. J f
B2.SDC .
,;"--:~-""",,",,.--=...-.._..._-,'';:
.FIXTUR~r UNIT CALCUlalON TABLE: Number of New Fi.S X Unit Equivalent = Fixture Units
(NOTE:' FOr remodels, calculate onl~e W additional fixtures) .
NUMBER OF UNIT FIXTURE
FIXTURE TYP'E NEW FIXTURES EOUIVALENT UNITS
Bathtub............ ......... .................................................
Drinking Fountain.....................................................
Floor Drain........... .....................................................
Interceptors For Grease/Oil/Solids/Etc.................
Interceptors FOr Sand/Auto Wash/Etc..................
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, C'1mmercial, Residential Kitchen........................
Urinal, Stall/Wali:.:....................................................
Wash BasinlLavatory, Single..................................
Toilet, Public Installation........................................
Toilet, Private...................... .................................
Miscellaneous:, ,TANI TOR'.s SoIR/:"
CREDIT CALCULATION TABLE:
calculate Credits separates.
I
tf z
f.2.
. .
/' Z
?t 4
/ 4
TOTAL FIXTURE UNITS
2
1
2
3
6
2
6
6
1
3
2
1/Head
2
2
1
6
4
.2
1-
+
J:
..t:
/"'-
=
:32
Based on assessed value. If improvements occurred after annexation date in table,
Year
Annexed
Rate per $1,000
Assessed Value
1979 Or befOre
1980,
1981
1982
1983
1.98.4
1985 '
$3.46
3.38
3.32
3.21
3.06
2.92
2.73
Year
Annexed
1985
1986
1987
1988
1989
1990
1991
1993
'I
Rate per $1,000
Assessed Value
"
$2.46
2.14
1.77
1.37
0.97
0.61
0.44
0.15
=
..fo, of?
---
3,-1'- X $ J/, :too
(Rate X Assessed Value)
X $
(Rate X Assessed Value)
Credit fOr Parc.el Or Land Onl,l' If Applicable
Improvement (if after annexation date)
=
CREDIT TOTAL = $ ..f~,~'ii
, ;"
.
.
]rC~rlg:)~ll9:j 1
@ !!)!i!~<!!!!~!~!!!:;
Job No. Q4\\40
NAME: \ }J
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
hrJ ~ ~U~r\OlS PHONE:~?:>'to~
?!6 Fffi\~. I~OJL. ~\~ STATE:t{.,ZIP C{~
ADDRESS:
LOCATION OF Ii'ROPOSED ~LDING SITE: (\ ."' _ . ~ . .
. Street Address if Known: YJD \ -t M()?J pl). \.tflWJJ. o-nt .
Platt Name: ~'((\ ffi tin F Tax Lot Number: \1\~~A.~4~~
1. DEVELOPMENT TYPE (Check appropriate dwelling(sl. SDC Calculations and dwelling type
definitions are on the back'>
A. Sin\!le Familv - Detached
Single Family home
Manufactured home not in a park
NO OF UNITS
X $400 PER UNIT _=
$
.
B. Sin\!le Familv - Attached
NO OF UNITS
s.
X $370 PER UNIT =
.$~O
C. Multi-Famih, Apartment
NOOF UNITS
X $277 PER UNIT =
$
D. Manufactured Home Park
NO OF UNITS
X $280 PER UNIT =
$
WPRD SDC
$040{D
$fJ
$ ')4 () (XJ
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See sac Credit Worksheet.
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced far Credit>
Lm ) , . o~fl
Community Services Divi i n
City of Sprin~eld
,q I_I
Date
l!lt