HomeMy WebLinkAboutPermit Building 1995-1-30
OWNER- ~~~ ~OR\
ADDRFt{ \)1) \.~~~
CITY: \. ' 1\ 0 D I J "\.0 Q.Q", STATE:~ ~ 0 ~
D.ill~_.____ h,.
, 1
1
;,." ":00.. ~ .......
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Oltice: 726-3759
ASSESSORS ~P'
LOT' N.
DESCRIBE WORK'
NEW V REMODEL
'-'\,
,/ , / -
5~<.."'- /f) ....c?6J 5. tL-1~ tJ,?:
.', ~4'\1 ~
JOB NUMBER - \ ~
225 Fifth Street
Springfield, Oregon 97477
.
#7;i/0S~
SPRINGFIELD
BLOCK:
'ADDITION
DEMOLISH
OTHER
f6y-~\*ni T\' )~
_ TAQ:T: ()tC{T)(j
SUBDtVISION;".& ~
PHONF' C-\,~ R ~?-/2__
ZIP:
C{--m~o
CONTRACT~':> NAME~ d ..L\":-~RESS
GENERAL:'\( ~\)O iJ n t1Ul.ljOD
PLUMBING: ~ ~ m ^-./
MECHANICA~: L r'\ )\l,tfLl \
_ r,
ELECTRICA : {J--,
CONST,
PP. Nlr~: A OR'
I7lU q
~..
'l(") S
. EO(dJ~
I\EXfr,Fn-, ()~NE ,
'/~"'" '6If)~7
\O~qS l~~7
\?;?.I.% ,~"4.24Bl
\~ .\1n4LtJ4I.~
QUAD AREA: _~~ 'S~
· OF BLDGS: \
OCCY GROUP: ~ "?)+M
~. .
9/
· OF STORIES:
WATER HEATER'
- OFFICE USE -
LAND USE: -.If!)O
· OF UNITS: ~.)
CONSTR. TYPE: JJ.;\/
Il)H
HEAT SOURCE:
RANGE: __~ /
"
FLOOD PLAIN'
ZONING CODE:-.LDJ2--
. OF BDRMS: ~+,~
SECONDARY HEAT: r
SQUARE FOOTAGE:<l.J}<
,'/
To request an Inspection, you must call 726-3769. This Is a 24 hour recording. Alllnspectlons 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.
~emporary Electric
D Site Inspoctlon - To be mado
after excavation, but prior to
setting forms.
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
b<'FOOtlng - After trenches are
q ~xcavated.
D Masonry - Steel location, bond
beams, grouting.
r\-7( Foundation - After forms are
J.2'J erected but prior to concrete
placement.
o
Underground Plumbing - Prior
to !tIllng trench,
)0;::;;( Underfloo~:::~~/ Mechanical
~- Prior t on or decking.
~ Post and Beam - Prior to floor
)L:j-.lnsulatlon or decking.
1's<1" Floor Insulation - PrIor to
~decklng.
-t=::::r'Sanllary Sewer - Prior to filling
>"""trench.
~ Storm Sewer - Prior to filling
~trench.
~ Waler Line - Prior to filling
'JA.t. trench. '
~Rough Plumbing - Prior to
~over.
REQUIRED INSPECTIONS
'f\/rRough Mechanical - Prior to
~ cover.
~ Rough Electrical - Prior to
~cover.
~Electrlcal Service - Must be
~approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
~Framlng - Prior to cover.
~Wall/Cetllng Insulation - Prior to
~cover.
~DrYWafl - Prior to laplng.
D Wood Stove .- f\flcr Installallon.,
D Insert - After llrcplace approval
and Installatlun ul unit.
'K'7'1 Curbcut & ApPIOClCh - Alter
~fo'rns are cm{;ll~d but prior to
placement of clIl1crelc.
'fVi Sidewalk & Driveway - After
~xcavation Is cUlnpletc, forms
and sub-base maler!::' In place.
o Fence - When ~comPleted. "
f")tf Street Trees - When all required
~rees are planted. .
TV1 Final Plumbing - When all
~plumblng w9rk Is complet.e.
~ Final Electrical - When all
~ electrical work Is complete.
~Flnal Mechanical - When all
?J mechanical work Is complete.
rs?('Flnal Building - When all
~~equlred Inspections have been
approved and bUilding Is
completed.
DOthor
MOBILE HOME INSPECTIONS
...
" ,
D Blocking and Set.Up - Wh,en all
blocking Is complele..
" '
o Plumbing Connections - When
home has been connected to
water and sewer.
o Electrical Conneclion - When
blocking, set.up, and plumbing
Inspections have been approved
and the home Is connected to
the service panel.
D Final - After all required
Inspections arc approved and
porches, skirting, decks, and'
venting have been Installed,
Lot faces .
L~I~A
~ Interior
~ Corner
Lol sQ. I.tg,
Lot coverage
Topography
,.
Total helgh< i~ ) ,
BUILDING PERMIT
ITEM SQ, FT,
::2.::z. 2.. ~
,,2f")~
~3fJ.,
Panhandle
Cul,de,sac
Main
X $/SQ, FT,
..si:P,2.~
/4/~
Garage
Carport. j
,._,.;"
,: "
:,'"1': ,:.:.. ,j :~.,;~~:~.&;~~.
Setbacks '
I HSE GAR I Acc'l
I
I
I
I'
."
IP.L,
IN
Is
W
E
~~ftif
" 'iV17'S
SYSTEMS DEVELOPMENT CHARGE (SDC)
. (B) 1 J C",7, .fi
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condition that the said
construction' shall, In all respects, conform to the Ordinance
adopted' by the City, 01 Springfield" Including the
Develop'ment Code, regulating the construction and use 01
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
",/ -'J. \.. a. ... V", r f) Plan ChE"ik Fee': C. .1 ,~,..-'
. . ".....,~~_c:.,;'.,;. . v:"
Total Value -
7 S" Receipt Number:
BUlldlngpermltFe~ 57/. _ ~J" " '
f " A~ c--~ '.-.t. Received By:
State Surcharge _ ;;"l7~ ~. - -, . ,~~: _ ..
,57i-/'5,$ &1--", '" /7//~ ',!
Total Fcc (A4":""L'tJ", ( ~ J""'lI Plans Reviewed By
U'J'P I .
PLUMBING PERMIT
ITEM
Fixtures
Resldenlial Balh(s) N' '? +- 2-
Sanitary Sewer FT,
Water FT.
...........
Storm Sewer FT.
Mobile Home
Plumbing Permit
State Surcharge It-:, "" -/. <7,<;0
, '
Total Charge (C)
MECHANICAL PERMIT '
Furnace '2.
Exhaust Hood
1..
Vent Fan
N'
./ '.
Wood Stove/lnsert/Flreplace Unl(
Dryer Vent
2..
Mechanical Permit
Issuance
State Surcharge /,' r -t II' ~
Total Permit (D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
Stale Surcharge
Sidewalk /312 ft
Curbcut 3~ ft
,
Demolition
FEE
'1.2Ll ~
? _~<;t:J
.~~~.t:.,
/2. ~~
1.tH)
-L2~
",;" C'O
~ '9'-
/ tf) ,C,O
?,Jl-.
C:;?, 1'2.
';L'}.$'o
/ &j-f<:?
/C)c>.&O .
~--.......
'M<j. ~-:.
{EfT- ~~~f,~
TOTAL AMOUNT DUE (excluding electrical) f. '-; ;ft
(A, B, C, 0, and E Combined) ~~?J. 7'1
State Surcharge
flbw ,a7~n_J
,
Total ~Iscellaneous Permits
, ,
'S THE PROPOSED WORK,tN THE. '
"__ . I
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
II yes, this application must be signed
,and approved by the Historical
Coordinator prior to permit issuance.
APPROVEP' '
I. j~:(ff
Systems Oev~lopmen,t qharge Is due on' all undeveloped
properties within the City limits which are being Improved.
,
ADDITIONAL COMMENTS
,
~mp As (P()?,~ so41~'
- (q1"-nS~
~1'fl'x::tOt)(i(\Q~)
\SM\A\!I~..~..U04;/' \q~
Qu.llWrio , ~ottnDiJ
~~
::J!iO~fl'h.T,~&.m-/T/" ~ '
"
By signature, I state and agree, that I have carefully examined
the compieted 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 lhe 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 ollhe 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 durln~ ~Jtru~t~n.
S~ture 7'~..:J~~
/
"
Datp
VALIDATION:
RECEIPT NUMBER
/&/3 J
1/3.?/J,F
c:; 7'19,7")'
~#~
DATE PAIl"
AMOUNT ,RECEIVED
/',
RECEIVED BY
.B NO. 9~/C;.5-3
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
.
,. ,
AnAcHMENT B1
NAME OR COMPANY: A'A~ #~
LOCATION: ~7.,o/r9~2. F~.d.-s.
/ /
DEVELOPMENT TYPE:
BUILDING SIZE:
1. SIQBM nRATN~
IMPERVIOUS SQ. FT. .2 g.22
2. SANTTARY SFWFR-CITY
NO, OF PFU'S 3'f-
(See Reverse)
3, TRANSpnRT A TT nN
LOT SIZE SQ. Ft.
X $0.209 PER SQ. FT. ~
X $43,26 PER PFU ($/~ 70. !.d)
NO OF UNITS X TRIP RATE X COST PER TRIP
X
X $436.19
~Y?I,/o)
$
$
SUBTOTAL (ADD ITEMS 1.2. & 3) $ 2 7?/. ??
2..
X l 0 / X $436. 19
X X $436.19
4. SANTTARY SFWFR-MWMC
NO. OF PFu's?9 x S17.19 PER PFU + S10 MWMC ADMIN,FEE $ 5'9iC.#..(;
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE) $ /f,?~
, 'IQIAI -MWMC SQC ~?O," ~--.....
SUBTOTAL (ADD ITEMS 1.2.3 & 4) $ ~ ~22...J"&'
5. 8DMTNTSTATTVF FFFS
BASE CHARGE (SUBTOTAL ABOVE) X .05
r-- r
~ L Date:
/ '-Mary Horni/iJ. PJ.E.
$BC CoordiilirOr
~~
//-..z;?- ?#
IQIAI snr;
$ 3 "':1 y. ~?'
B2 . SDC .
FIXTURE UNIT CALCULelON TABLE: Number of New FiXls X Unit Equivalent = Fixture Units
(NOTE: For remodels, calculate only the NEI additional fixtures)
NUMBER OF
NEW FIXTURES
Bathtub................,.,...,.,.,...........,.............................. .
Drinkin9 Fountain.....,....,............,.............................
Floor Drain................................................................
Interceptors For Grease/OiI/Solids/Etc............,....
Interceptors For SandlAuto Wash/Etc..................
Laundry Tub/Clotheswasher...................................
Clotheswasher - 3 Or More.....................................
Mobile Home Park Trap 11 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, Single..................................
Toilet, Public Installation..........................,.............
Toilet, Private...........,...........................................
Miscellaneous: ,Y,I,H/ "'J?'.s .$.''''''''
FIXTURE TYPE
"5
2.
2
4-
4
TOTAL FIXTURE UNITS
UNIT
EQUIVALENT
2
1
2
3
6
2
6
6
1
3
2
1 /Head
2
2
1
6
4
..(
=
FIXTURE
UNITS
c..
4
f
.,.
1(_
-;:4
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table,
calculate credits separates.
I
Year
Annexed
1979 or before
1980
, 1981
1982
1983
1984
1985
Rate per $1,000
Assessed Value
$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 for Pa~cel or Land Only If Applicable
Improvement (if after annexation date)
'5, "I " X $ 4, 07J7')
(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
~
/ 'J. i"1
----
CREDIT TOTAL = $ I?J'~
, ,
.
,
.
o y!i!leol!!!~!~~,~
Job No. ~\loS0
SYSTEMS DEVELOPMENT CHARGE
WORKSHEIT
NAME: ~~\l~~~ ~ J::L; PHONE: q~L\ .f)3~~
ADDRESS: ~,Q.~ fA3, ~{JIO~STATE:Qt.zIP_q142.1tJ
\ } '
LOCATION OF JilROPOSED BJ.l}l,9!J'l.Q SITE~ (\ ~ () ~ I J '_ ,) "
, Street Address if Known: ~~) 't' \'\'()'I,..... \t1\St ~\;\ tG-/
Platt Name: ~ Tax Lot Number: \W~r06t{W'
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the back.!
A Sinl!le Familv - Detached
Single Family home
NO OF UNITS
B. Sinl!le Familv - Attached,
NO OF UNITS ~
C. Multi-Familv Aoartment
NO OF UNITS
D. Manufadured Home Park
NO OF UNITS
Manufactured home not in a park
X $400 PER UNIT _=
$
.
X $370 PER UNIT =
, $ Jj[) ,ciJ
X $277 PER UNIT =
$
X $280 PER UNIT =
$
WPRD SDC
$ '}4D. CD
$ ;/ \
$ f}t{) pcJ
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet.
3. TOTAL WPRD NIT SDC ASSESSED (If SDC reduced for Credit!
C. hS'~~D' ,', 4fM..
ommuntty ervlces IVlSlon
I I 5~ I 'l1i"'
Date
.
'I"e \0 &1'(\ (\ f) ,
~O~;~~aI'IL.O~ ---
ell 1.0~i~\l~
97477 V.....3...::-- ,~ IV':-
726-~ Si\l~e""e
p....:."o~~,.(l
.
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPEctION REQUEST:
OFFICB: 726-3759
1. LOCATION OF INSTALLATION
4rSe -~.,.n ~r77l.ul-
. LEGAL DESCRIFTION
/~(!) Z. D9/'J7:) l'h '2-~tn)
"
~;~::ION
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 Contractor ARC ELECTRIC
Addres85783 HWY 99 SOUTH
City EIIGENE
Phone 741-0494
Supervisor License Number
20985
Expiration Date
Constr Contr. Number
--
006'0'3
Expi'ration Date
, Si~e 'YJ supe7is~n.!. Electric~,
/0. .I fL" -I' _<---"/ fJ a-1,~
Owners Name
Address
Ci ty Phone
"..."" INSTALLATION
The. installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
DATE:
RECEIPT I:
RECEIVED BY:
1/~{)/7' .J
I i&i/-!,S'
A"?/ + A
1 -. " -
SPRIN.tILO
'City Job Number
3.
COHPLETE FEE SCHEDULE BELOV
q1/~S3
A.
New Residential-Single or
Hulti-Family per dwelling unit.
Service Included:
It ems Cos t
1000 sq.ft. or less ~
Each additional 500
sq. ft or portion
thereof 2-
Each Hanuf'd Home or
Hodular Dwelling
Service or Feeder
B. Services or Feeders
Installation, Alterations
or Relocation:
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
$ B5.00 .J!lPl'~
$ 15.00
:3 0,"0
$ 40.00
$ 50.00
$ 60,00
$100.00
'$130.00
$300.00
$ 40.00
C. Temporary Services nr'Feeders
Installation, Alteration or Relocation
,200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000
$ 40.00
$ 55.00
$ BO.OO
volts see "B" above
D. Branch Circuits
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00
$ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res $ 20,00
Limited Energy/Comm $ 36.00
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL '
----
~.-
/,0."0
tA ()~
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