HomeMy WebLinkAboutPermit Building 1995-1-10
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOT'
OWNER: (/,{!t~
ADDRESS:, fr9'7~f?
CITY' .<;4.h,/
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DESCRIBE WORK:
/.1; n /,/
NEW K REMODEL
ADDITION
.
G.#' 9ofll"!)
/i!u
STATE:
~/t
-t/'..,.>
J1.u'/'" }("
,
DEMOLISH
OTHER
-
.
. -
A$" 27IU-!> S. ~IM;& Ii.
q~g?
. JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
PHON~'
ZIP:1/~')9'
. ,
CONST.
CONTRACTOR' EXPIRES
~-~ "-P'??I \.~.q;
, !:Pd) ILP 1i',f~t1 4<;
CONTRACTOR'S NAME ADDRESS
GENERAL: ~.' It 'NI/"~L h~ fi~?-a.I'
PLUMBING: a ".JX ?Iu .,,1/...1"
MECHANICAl'
ELECTRICAL: .Po 1/4- It;' E:/", ~_?:., r
" . "'114'17..
PHONE
7 :J..I!:-rr;zj
~fi'-:J 1~r-
\\ .t~.L1~""_J9Y2... .
QUAD AREA: \ Q\\')( i ) LAND USE: OFF'rt IJD-
. OF BLDGS' .-1 . OF UNITS: --d. ZONING CODE: \,.A,{W .
OCCY GROUP: t=\3-t-AA CONSTR. TYPE: V ^ ) . OF BDRMS: 3-T~"
. OF STORIES' !1. HEAT SOURCE: \.L) I--l SECONDARY HEAT: ~0
WATER HEATER: _r ~ RANGF: r J (,SQ\LA~ FOOTA)~ ( 0 it J)
. . , I.'),,() T4> L. 0 11
\,
To request an Inspection, you must call 726.3769. This Is a 24 hour recording. Alllnspecllons 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
o Sfte Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumblng/Electrlcall
Mechanical - Prior to cover.
f\tl ~ootlng - After trenches are
I excavated.
o Maaonry - Steel location. bond
beam., grouting.
rp Foundation - After forms are
erected but prior to.concrete
placeme~t.
D Underground Plumbing - Prior
to filling trench.
CSl"UnderUoor Plumbing I Mechanical
~- Prior to Insulation or decking.
rtzl Post and Beam - Prior to floor
r Insulation or decking.
~ Floor Insulation - Prior to
~ decking.
Sanitary Sewar - Prior to filling
trench.
Storm Sewer - Prior to filling
trench. '
1'5<1 Water Line - Prior to filling
r~ trench.
~ Rough Plumbing - Prior to
Icover.
REQUIRED INSPECTIONS
~ROU9h Mechanical ~ Prior to
~ ~over.
m Rough Electrical - Prior to
/ cover.
j6Electrlcal Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
? Framing - Prior to cover.
iVf Wail/Ceiling Insulation - Prior to
( cover.
~ Drywall - Prior to taping.
o Wood Stove - After I~stallatlon.
o Insert - After fireplace approv~1
and Installation of unit.
~curbcut & Approach - After
forms are erected but prior to
placement of concrete.
~Sldewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
I
o Fence - When completed.
D Street Trees - VYhen all required
trees are planted.
FLOOD PLAIN:
k11' Fino' Plumbing - When all
~ plumbing wc;>rk Is complet.c.
I'\7f i=lnal Electrical - Wohen all
~ electrical work Is complete. C
f\(t Final Mechanical - When all
r mechanical work Is complete.
~Flnal Building - When all
requIred Inspections have been
approved and building I.
completed.
o Other
MOBILE HOME INSPECTIONS
o Blocking and Sot.Up - When all
blocking Is complete.
o Plumbing Connections - When
home has been connected to
waler and sewer.
o Electrical Connection - When
blocking, sel.up. and plurt;lblng
Inspections have been approved
and the home Is connecled to
the servIce panel.
D Final - After all required
Inspections arc approved and
porches, skirting, decks, and
venting have been Installed.
:~,i "
~: : ' "
'~ .. ~ot ~ype. ...
.. , ,
Lot facos
Lot sq. Itg. X Interior I PL.
IN
Lot coverage Corner
Is
Topography Panhandle
Total height c!)!].! Cul-de-sac ,. W
. '.. . .' ~.". ,
,E
BUILDING PERMIT
ITEM
SQ. FT.
r4,?JfJ
~ain
Gaeage
Carport
Total Value
BuildIng Permi t Fee
Slate Surcharge t.30.o
Total Fee
. .
","., !::".~,,:~,.;:~';:~:l
Setbacks .
-~ THE PROPOSED WORK IN THE _
. HISTORICAL DISTRICT, OR ON '
THE HISTORICAL REGISTER?
II yes, this application must be signed
and approved by the Historical
" Coordinator prior to permit Issuance.
"~ ,', .,\.~,
APPROVED:
HSE GAR ACC' I
I
I
x, ~1~.?1)= J~A~m I
\~. IT)., lo;1Qt
(A)
I~ X ,fiS
4C\~. 2.S
~ .?;lp
\'5~~.11'
SYSTEMS DEVELOPMENT CHARGE (SDC) :
(B) J '3~"(,.""
PLUMBING PERMIT
ITEM
Fixtures
,
Residential Bath(s)
N,r:Jy..Q
Sanitary Sewer
FT.
FT.
FT.
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge -t:!:f:;/t;
Total Charge (C)
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
N'
Wood Stovellnsertl Fireplace Unit
Dryer Vent
Mechanical Permit
Issuahce
State :Surcharge
Total Permit
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk 3.Q It
Curbcut ...~O It
Demolition
~1\~a~~~ 11M
Total Miscellaneous Permits (E)
FEE
3'){) pO
\",-'iql) pO'
f"1,),W
:::s4-~ .1eO
q.oo
(A.OO
10 ,ou
(D)
&],CD
TO pb
d) . l/..a
,~0j.llo
~ ,~-(j
\~ 4n
41) .OU
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C. 0, and E Combined)
,,~ PA H3
, '
. ,,',"
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condition that the said
construction shall;ln all respects, conform to the Ordinance
adopted by the City of Springfield, Including the
Development Code, re'gulating 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:
Recel pt Number'
Received By:
Plans Reviewed By
Date
Systems Development Charge Is due on all undeveloped
properties within the City IImlls which are being Improved.
ADDITIONAL COMMENTS L
\\H~Hi.L ~n o1..lXillP
. 0_~ + T'. I \ /")lY) .G.nt )
~~OX f'rrt n): \ CAl O~
"~~u (;()Cy'\. \.~~I).)
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 Ihe Laws
of the State of Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be made 01 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
on the te a es during construction,
12_:// 4' ~~_
.z-_
/'
Date
"/- /,-, -9~-
/
VfDATION: c:::,~
RECEIPT NUMBER lS,c\'. -
DATE PAIr> \ - \ l) 'ldS
AMOUNT RECEIVE~~~O. R ~
RECEIVED BY 'P'l\l ~
~ ,J ·
~-.
ATTACHMENT B1
.JOB NO. .31/~'it7
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: /(J/L1JAht U)'LE~Y
LOCATION:,21.2.1J.l13/ S. Ct,6Vc.RJ."f;AF ..c:.",,,,-p
DEVELOPMENT TYPE: #$.kJ J:)H/"~fM
(iris)
RH-'AT
BUILDING SIZE:
1. STORM DRAINAGF
IMPERVIOUS SQ. FT.
I.OT SIZF
SQ. Ft.
2.5""0 .
X $0.209 PER SQ. FT.
~
2. SAMlIARY SFWFR-r.ITY
NO. OF PFU'S
(See Reverse)
3. TRA~spnRTATTnN
NO OF UNITS X TRIP RATE X COST PER TRIP
~2.
X $43.26 PER PFU
.~
..z.
X /.0/ X $436.19
~8'I,/O) .
X
X
X $436.19
X $436.19
$
$
SUBTOTAL (ADD ITEMS 1.2. & 3) $ :z 1?ao. ~r;,
4. SANTTARY SFWFR-MWMr.
NO. OF PFU'S ~2 x $17.19 PER PFU + $10 MWMC ADMIN. FEE
(Use PFU Total From Item 2 Above)
$ S'~o.o~
MWMC CREDIT IF APPlICABLE (SEE REVERSE)
.' . . TOTAl -MWMr. SOC
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
$ ?O.~li'
$rS"/'L c:,/')--:>
-,
$ "{ "'"26.0,"
5. AOMINISTATTVF FFFS
(d.'fD. &D ~
.'
//-/5"- 9f!
IQIAI Sor.
$ s';'3~.or;,
B2.SDC .
r/,. ..... .
_..._.......;.~_. .. . . , .
~.. .
". . .
, '.'.' .
FIXTURE UNIT CALCULATION TABLE: Number of New Fixture Unit Equivalent =.Fixture Units
(NOTE: For remodels, calculate only the MfI additional lixtures)
NUMBER OF
NEW FIXTURES
FIXTURE TYPE
Bathtub.. ..... .... .... ...... .., .................. ............................
Drinking Fountain. ....................................................
Floor Drain. ......................... ............... .......................
Interceptors For Grease/Oil/Solid.s/Etc..... ............
Interceptors For Sand/Auto' Wash/Etc...........;.,.....
Laundry Tub/Clotheswasher:. ;:;;.::-...........................
Clotheswasher - 3 Or More.....................................
Mobile Home Park Trap (1 Per Trailer)..................
Receptor For Relrigerator/Water Station/Etc........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Stall.......................:.........................
Shower, Gang.., ......... ............................... ................
Sink: Bar, Commercial; Residential Kitchen........................
Urinal, Stall/Wall..:....................................................
Wash BasinlLavatory, Sin9Ie..................................
Toilet, Public Installation........................................
Toilet, Private............................................ ........ ..,
Miscellaneous: .':' iT,,,,,, ",..'.$ ShV~ .
.2
2
".
2
4
4
TOT AL FIXTURE UNITS
UNIT
EOUIV ALENT
". .
2
1
.2.
3
6
.2
6
.6
1
3
2
1/Head
2
2
1
6
4
.1.
FIXTURE
UNITS
4
4
4-
4-
Ib
"
~2
CREDIT CALCUL~TION TABLE: Based on assessed value. If improvements occurred alter annexation date in table,
calculate credits separates.
Year
Annexed
Rate per $1,000
Assessed Value
1979 Or belore
1980
1981
1982
.. '9113
1984'
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
'.
. .'
Credit'Ior'P;lrcel Or Land Only If Applicable
- .- - -- - -.---
- _. -. -. -.. ..
=
..
.... ,~. "
Improvement'Uf after annexation date)
". ')..; ".
.......
'" '"J ~ .
1,#(;' X $ /1. :rD"
(Rate X Assessed Value)
- X $
(Rate X Assessed Value)
=
Rate per $1,000
Assessed Value
$2.46
2.14
1.77
1.37
0.97
0.61
0.44
0.15
40. ?~
CREDIT TOTAL =$ 10, 'fl?
"
.
.
~,... Wi llama lane
'(;(1' Park & Recreatio~ District
Job No. Cf41log1
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME, \ ,)\ \ \ i(lm (\I'\ l\ 01'1 Y
ADDRESS: fB1J<r1 9rtY\~ J~' p~
PHONE; 121o.1~?-:<)
STATE: ~ZIP~'
LOCATION OF "'ROPOSED BUILDING SITE/z73 J I.. / /J L .
. Street Address if Known: 272q75 ClOVU-:ILtVF t/lJ,O
. I
Platt Name: GJC\flln.rL.JI Tax Lot Number: .tlD3QI)4,~
~ln.t
1~ DEVELOPMENT TYPE (Check appropriate dwelling(sl. SDC Calculations and dwelling type
definitions are on the back.)
A. SiOl,le Familv - Detached
Single Family home
NO OF UNITS
B. Single Familv - Attached
NO OF UNITS L
C. Multi-Familv Aoartment
Manufactured home not in a park
X $400 PER UNIT _=..
. $
.
X $370 PER UNIT =
. $!)j/).OO
.i
NO OF UNITS
X $277 PER UNIT =
$
D. Manufactured Home Park
NO OF UNITS
X $280 PER UNIT =
$
WPRD SDC
$ 2J{) .c;O
$;;:Y
Mn 'ex}
$'/11)..
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet.
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced for CrediO
~~~~ o,l
1
( 0/-35
.
S'-GFIELD
The following project a. submittod has the followin
zoning, and doea not require specllic land use
approval,
225 FIFTH STREET . 11\ PI?-
SPRINGFIELD OREGON 97477 Zonina
INSPECTION REQUEST: 72~q~9 k I 0- q 5 Ci ty Job Number
OFFICE: 726-3759 . . ,.1
Authorlzod SlgnatureJl,..L."'': . e3KP:""'-= :-RE SCHEDULE BELOV
l({)~?t~~ ~I~ DnO~ JnNew Residential-:Single or
- - _. .U uy- Mul t i-Family per dwelling uni t.
. ~D~PTIll.tl....-.A ~\ . . Service Included:
~ llmV ... Items Cost
c-1 $ 85.00
d $ 15.00
$~\S~~ION ~'tlCillP
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical ContractorlD.l.'f.~ f kIT
Address .~/L~t?- U(' \( OJfYc1P ~,,~
City ~ Phone}'~I~'2...:
supe~:~nse Number \9:..'" \ S
\\).\.~~
Expiration Date
Constr Contr. Number -YI~-Y2__
E .1 . D
xplratlOn ate
\ \. \~.Q~
Si~ure o~superViSing Electrician
AI. /':1 ~~ .
Owners Name\u.1\\\QjY\ ~~. D.
Address ro~L1j1 f 1f'O'\ 'L ~
City ~~.~ p~one 11Jtr\aJ
OVNER INSTALLATION
The installation is being made on
property I own'which is not intended
for sale, lease or rent.
Owners Signature:
~~~E~--------- "I ~7a--qc:
RECEIPT 11: ......J.. . j('\ 4-(:~
RECEIVED BY,( /)// f.A"-7' =-.J
" ~
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular. .Dwelling
Service or Feeder
B.
Services or Feeders
Installation, Alterations
or Reloc'!tion:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to' 1000 amps
Over 1000 amps/volts
Reconnect Only -
,
Sum
JJD
Sf}
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C.
Temporary Services or'Feeders
Installation, Alteration or .Relocation
$ 40.00
$ 55.00
$ 80.00
see "B" above
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
Branch Circuits
"
New, Alteration or Extension Per Panel
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
One Circuit
Each Addi tional
Circuit or with Service
or Feeder Permit
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$ 35.00
$ 2.00
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
sJ.ri) .CD
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