HomeMy WebLinkAboutPermit Building 1995-2-7
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726,3769
Office: 726,3759
LOT'
(#?#~) 5~6 ~
. 2 ?t:J/ - ~ Ci.1v..t~,/.iMtr: fA1:J
JOB NUMBER 9f/t.~ 6
.
OWNER: t,,/IIIt~_- (1LII....,_
.;
ADDRESS' 8.3 7.2. 2 E'..._, R.. ~
CITY' <;'_..t:/./
,
DESCRIBE WORK'
flu, /r/
NEW \L
REMODEL
CONTRACTOR'S NAME
GENERAL: f'Y((l7 gui/c/,__ Jir/
PLUMBING: 0" uj"r P!,~_'".. /'
MECHANICAl'
ELECTRICAL: Va ve 'e ~7:;-u
...
QUAD AREA: -' RlU (, )
- /
OCCY GROUP: K:)r,tv\
2-
7,
. OF BLDGS'
. OF STORIES:
WATER HEATER:
IY
STATE:' & I?
,I/IU../
J')uJ!,.. Jt'
PHONE:
ZIP: --2:2..Y ~ s::-
ADDRESS'
CONST.
CONTRACTOR'
REQUIRED INSPECTIONS
rW~U9h MechanIcal ~ PrIor to
T ~over.
~OU9h. Electrical - Prior to
T cover.
~Iectrlcal Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facIng
materials and framing Insp.
~ Framing - Prlorto cover.
~all/Celllng Insulation - Prior to
( cover."
IfDDryWall - Prior to taping,
b Wood Stove - After Installation.
D Insert - After fireplace approvlll
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.
D Fence - When completed.
D Street Trees - When all required
trees are planted.
EXPII}J'..S
) O('VL<)
0( . d. fJ cts
PHONE
) 2. (:-/r:L. ?
~f?ft-r..:J.K.1-
,
ADDITION
DEMOLISH
OTHER
~J..~LEJ:L!" R~ ~ ry2L./
, fl{,\D \to
," ,', v ~'~11
... f, ,'.
, "
.~
-
\\ .r">'~''(-J?Y~
- OFFICE USE -
\~20
· OF UNITS: ?-
CONSTR. TYPE:-'1[rV
HEAT SOURCE: W+-\
F./
LAND USE:
RANGE:
FLOOD PLAIN'
ZONING CODE: ~
. OF BDRMS: (\-\:...~, ,.
SECONDARY HEAT:-P1
SQr;.~~~GnE~~
/'
,
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.
~,
<::. '
D Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumblng/Electrlcal/
Mechanical - Prior to cover.
~otlng - After trenches are
cavaled.
Mesonry - Steel locallon, bond
beams, grouting.
1:Found8t10n - After forms are
erected but- prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench,
~ndernoor Plumbing/Mechanical
- Prior to Insulation or deckIng.
ost and Beam - Prior to floor
Insulation or decking.
rWFloor Insulation - Prior to
{ decking,
~anltary Sewer - Prior to filling
-Tn trench.
[A'Storm Sewer - PrIor to filling
r trench.
~aler Line - Prior to filling
trench.
ough Plumbing - Prior to
cover. .
~
~ Final Plumbing - When all
7 _ plumbing w9rk Is complet.e.
~ Final Electrical - vv.hen all
r electrical work Is complete. ~
bZ'l Final Mechanical - When all
r mechanIcal work Is complete.
'Final BUilding - When all
required Inspections have been
approved and building is
completed.
DOthor
MOBILE HOME INSPECTIONS
D Blocking and Sot.Up - WheCl all
blocking Is complete.
D Plumbing Connections - When
home has been connected to .
water and sewer.
D Electrical Connection - When
blocking, set.up, and plun;lblng
Inspections have been approved
and the home Is connected to
the service panel.
D Final - After all required
Inspections are approved and
porches, skirtIng, decks, and
venting have been Installed.
.,t.
,.
','
Lot 'faces
"
, LOI-~ype.'
K Interior
Corner
Lot sq, ltg,
Lot coverage
Topography _
Total ~elght ~
Panhandle
HSE GAR' ACc'I
I
I
I
.., <,." .,: \ - -'I~
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
; ..~.'.
., I:.,.
I PL,
IN
Is
Iw
I"', " '"' .
E -
Cul,de,sac \
L '\,." ,"" ",
BUILDING PERMIT
SQ, FT,
~J') I ()
440
ITEM
X $/SQ, FT,
..51p. 2/)
l4,/D
t>.1aln
Ga(age
Carport
Total Value
Building Permit Fee
Slate Surcharge -t ~
Total Fee
(A)
VALUE
..It~
} L~ .415
.18~2S
~Kb.
S~<? \ l
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
$ -:r"/Sf/,13
PLUMBING PERMIT
ITEM
',-
Fixtures
>
ResIdential Bath(s)
N'~ 9..
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
Issuahce
State:Surcharge -t 3%
Total Permit (D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
SIdewalk ~ It
Curbcut :31.2 ft
Demolition
J1r:t^h~e 0 1 j l Qll)
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B. C, D, and E Combined)
FEE
c32Jl{!)
~W.aJ
c95. (nO
2A'S,lLO
q,co
J ::l .00
J CD'
n.
~').oo
/ (),OU
J, /(o
301. lJ.o
\C\~
\co~O
/\ f,' i:;;
\V.a
44t.=,r)~
.: '~", t:.:,.l:';~~;-i.&.:~~'..
'. THE PROPOSED WORK IN THE_
"'HISTORICAL DISTRICT, OR ON '
THE HISTORICAL REGISTER?
If yes. this appllcallon must be signed
and approved by the Historical
. Coordinator prior to permit Issuance.
Setbacks
.' ...,~
APPROVEP'
This permit is granted on the express condillon 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 tlme
upon violation of any provisions of saId ordinances.
Plan Check Fee'
Date Paid: ~Jj_\Y
Receipt Number:f'li~
Received By: ~
\
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties within the City limits whIch ar~ being Improved.
ADDITIONAL COMMENTS
(' 1 \..h.Wlto J ~ 0 U YJ.Jl,t.;
4lIll
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By signature, I stale 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 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 site at all times during construction.
Signature
[) ...:-z;? /J....&:
- ..7
Date ., - '/ - 5',---
VALIDATION: r )
RECEIPT NUMBER (Lotl'"f<>
DATE PAin, ,.C) ,1 .US ,
AMOUNT RECEI,VEO r~'\.\~ r::t.J
RECEIVED BY H\\r'C\. .J
~
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.,......
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. ",". . ~
. .' '.. .
.
~.. :.'~' .... . '.
JOB NO'-'~/t; '?~
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
ATIACHMENT B1
NAME OR COMPANY: _ta~L./Ah'1 C Aj..L.~ V
LOCATION: 2 ;r,-y" S- 5. C.",dU,s:~J...BA-F ,)..ot:JP
DEVELOPMENT TYPE: !I~/V OUPhE,X
"
,'.
BUILDING SIZE:
1. ~TORM OR4INAGE
IMPERVIOUS SQ. FT.
lOT SPF
. '
5Q. Ft.
2.4-10
, X $0,209 PER SO: FT. (S~
2. SANTTARY SFWFR-CTTY
NO. OF PFU'S '
(See Reverse)
3, TRANSPORTATI0tl
,NO OF UNITS X TRIP RATE X COST PER TRIP
'3 2.
, X $43.26 PER PFU
.~ ~'1,';)
_...-/
;L
X /. ~ / X $436, 19
~8'F,/,/~ ')
------
X
X
X $436.19
X $436.19
$
$
SUBTOTAL (ADD ITEMS 1. 2, & 3) $..2 '? 7 $'.38
4, SANITARY SFWFR-MWMC
NO, OF PFU'S ?.2. x $17.19 PER PFU + $10 MWMC ADMIN.FEE $ f>,,~.t:J?
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE) $ ~~,-jI'ii
MAl -MWMC SOG 1~9. ~
SUBTOTAL (ADD ITEMS 1.2.3 & 4) $ 3299.?'Y
5, ~OMIN1STATIVF FFFS
0~'
BASE CHARGE (:U~Tr: ABOVE) X ,05
~ ~k 'Date: //-/s--9~
/ M ry crrnig, PU.
SO oordi nator
MAl sOC
$ '5 4s"- 1 3
B2.SDC '
;",..,..L:.."':' "
.' ,e' - "
FIXTURE UN'IT 'c~ALCULA TION TABLE: Numbcr of Ncw Fixtur~ Unit Equivalcnt =, Fixturc Units
(NOTE: For rcmodcls, calculate only the N.E.I additional fixturesl
NUMBER OF
NEW FIXTURES
FIXTURE TYPE
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, CommerCial; Residential Kitchen........................
Urinal, Stall/Wall: ::................................................,...
Wash Basin/Lavatory, Sin9Ie..................................
Toilet, Public Installation........................................
Toilet, Private......,........... ..........,.............,.,..........
Miscellaneous:' .': ,\ iTA'" rcP~ ShYK
J.
2
2
4
4-
TOTAL FIXTURE UNITS
UNIT
EQUIVALENT
"',
2
1
'2,
3
~
, ' 2
, 6
'6
1
3
2
l/Head
2
2
1
6
4
.2.
FIXTURE
UNITS
4
4
4
4-
_/b
~2
,,'
=
If improvements occurred after annexation date in table,
CREDIT CALCUL~TION TABLE: Based on assessed value.
calculate credits separatcs.
,
\
I
Rate per $ 1,000
Assessed Value
Ycar
Anncxed
Rate pcr $1,000
Assessed Value
Year
Annexed
1985
1986
1987
1988
1989
1990
1991
1993
1979 or before
1980
1981
1982
" '9~3
19B4'
1985
$3.46
3.38
3.32
3,21
3.06
2.92
2,73
"
$ 2.46
, 2,14
1.77
1.37
0,97
0.61
0.44
0.15
"
Credit' for P~rcel or Land Only If Applicable
s.~c. X $ /1. 10"
(Rate X Assesscd Value)
- X $
(Rate X Assessed Value)
l~provelT\ent'(if after annexation date}
=
=
40. ?h'-
J. '. ,.
CREDIT TOTAL = $ 10. 1'l?
'. ....:
..
.
~,... Willamalane
'-(,g Park & Recreatio~ District
"
.
JObNO.~
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
"
NAME: \ l)\\\ to, N\ (\('\ l\ on 1)
-" 0-
ADDRESS: f61)?CC 9~~) ~~ Pet
PHONE: 12b.I~? ~
STATE: 9tL.ZIP~'
LOCATION OF j;lROPOSED BUILDING SITE:
Street Address if Known: c&Jlo ~ ..... ct2laS f\() 01()\ '\0 .r1 o..a...ts '
Tax Lot Number: 'flD3QfL4.\.-:J'fX~fJD/IJ02fJD
, ' (P1o)
Platt Name: GJC\ffirJflJ[
, ~Ln:t,
1'. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the back.)
A. SinlJle Familv - Detached
Single Family home
NO OF UNITS
B. Sinl!le Familv - Attached
NO OF UNITS L
C. Multi-Familv Aoartment
NO OF UNITS
D. Manufactured Home Park
NOOFUNITS
WPRD SDC
Manufactured home not in a park
X $400 PER UNIT ,p,
, $
I
.
X $370 PER UNIT =
, $!}j/).OO
1
X $277 PER UNIT =
$
X $280 PER UNIT =
$
$ 2ft) .CXJ
$,Y'
Mf"l'CO
$.171)..
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 for Credit!
:~m~~
!l, 1 I q~
Date
;,1
"
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