HomeMy WebLinkAboutPermit Building 1995-4-3
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
..
SPRINGFIELD
~t@
LOCATION OF PROPOSED WORK' 5'";:l92. ~"9Y r~~""T~<AL
ASSESSORS MAP: -/J?.z::><.-A .Y-//
y~~~~y /?3s:->/"~
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,
LOT:
OWNER'
ADDRE~~'
CITY'
BLOCK'
,
'.
STATE: '
~~.
DESCRIBE WORK: 0/:~,/~~-~y...?vq~~......v--
NEW REMODEL ADDITION DEMOLISH '" -OTHER
CONTRACTOR'S~~,. .
GENERAL'~~~': ;...J"
PLUMBING'
MECHANICA' '
ELECTRICAl'
QUAD AREA'
~ e.-~~
,
--
. OF BLDGS:
OCCY GROUP:_tYl.
t
. OF STORIES'
'WATER HEATER'
I
-
ADDRESS
CONST,
CONTRACTOR'
.:.
JOB NUMBER
"9 Sf //'7t:::>
0.\ "
- OFFICE USE -
LAND USE:
Ij:f,()
I
VN
225 FlLlh Slreel
Springfield, Oregon 97477
TAX LOT' ~~/=<<:!>
SUBDIVISION:
PHON'"
? Y ;>..-?,'<:~
. OF UNITS:
CONSTR, TYPE:
-
HEAT SOURCE:
RANGE: _
ZIP: ~ :?y? ')
EXPIRES
PHONE
FLOOD PLAIN:
ZONING CODE: ~D rz..
. OF BDRMS'
SECONDARY HEAT:
SQUARE FOOTAGE: _~D,
To request an inspectIon, you must call 726.3769. This Is a 24 hour recording. AI/Inspections requested before 7:00 a.m, will be
made the same working day, Inspections requested after 7:00 8.m. will be made the tollowlng work day.
o Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o
Underslab Plumblngl Electricall
Mechanical - Prior to cover.
[$J
o
Footing - After trenches arc
excavated.
Masonry - Steel location, bond
beams, grouting.
J\t1 Foundation - After forms arc
~ erected but prior to concrete
placement.
o
Underground Plumbing - Prior
to filling trench,
o
UnderUoor Plumblngl Mechanical
- Prior to Insulation or decking.
o Post and Beam - Prior to floor
insulation or.decklng. .
,'. ...
o Floor lnsulatlcin ...:- PrIor to
decking. _ "'-
o Sanitary Sewer - Prior to filling
trench.
rX1 Storm Sewer - Prior to filling
~ trench,
o Water Line - Prior to filling
trench.
o Rough Plumbing - PrIor to
cover.
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
,
"
D Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace -, Prior to facing
materials and framing Insp.
~ Framlng,- Prior to cover.
o Wail/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping,
o Wood Stove - After Installation.
o Insert - After fireplace approval
and installatIon of unit.
D Curbcut & Approach - After
. '. _ forms are erected but prior to
',: placement ot concrete.
o Sidewalk & Driveway - After
excavation is complete. forms
and sub.base material in place.
o Fence - When completed.
D Street Troes - When all required
trees are planted.
o
Final Plumbing - When all
plumbing w~)rk Is complet.e.
D Final Electrical - When all
electrical work Is complete.
D Final Mechanical - When all
mechanical work Is complete.
rv'l Final Building - When all
, required inspections have been
approved and building Is
completed.
OOthor
MOBILE HOME INSPECTIONS
o Blocking and Sel-Up - Wilen 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.
D Final - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
Lot tacos
Lot ~yp.
Interior
Lot sq, ftg,
Lot coverage
Corner
Topography
Total height
Panhandle
-!!:5
Cul-de-sac'
'.~
,..; ;~,:';i~ \~:.\.
_S THE PROPOSED WORK IN THE,
"'HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prIor to permit Issuance.
Setbacks
I P.L. I HSE ' GAR' ACC I
I N I
I S I
Iw I I I I
LLLLJ
BUILDING PERMIT
ITEM SQ, FT, X $/SQ, FT, = VALUE
..:s..i5'iClO
bb. SQ.
l.\.~
b l. Q).
SYSTEMS DEVELOPMENT CHARGE (SDC) if>
(B) i$IS"1~
Main
~
G~ra8B
$__
~~'
/f~/(>
/<?/~
Carport
Tolal Value
Bullding Permit Fee
State Surcharge ~.t>!. + '?, ~
Tolal Fcc
(A)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) NO'
Sanitary Sewer FT,
Water FT,
Storm Sewer FT. So
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
\.~s~ 3.""6
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobtle Home
State Issuance
State Surcharge
Sidewalk
ft
ft
Curbcut
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, 6, C, 0, and E Combined)
" _'\,~U~:
~e:J jle:>
FEE
~.lO
~s.sm
.l,~
~l..cO
q5
a5
~l{B.oI
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express conditIon thai the said
construction shall, in all respects, conform to the Ordinance
adopted by the Cily ,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: ~. :::~
?-~ '9">"
Date Paid:
Receipt Number: /h-::.,... /
Received By: ~____?_
~~R <7-
Plan,lJ1evlewed By
~ Jc9.l.l! "rS'
, Dat~
Systems Development Charge Is due on all undeveloped
properties within tho City limits which are being improved.
ADDITIONAL COMMENTS
-
L\"r~";h''> ~~.~.(..~ W-~'\)
~--MI.~,\l
"
By signature, I state and agree, that I have carofUlly 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 tho City of Sprlngfleld, 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.
J further certify thai only contractors and employees who
are In compliance with ORS 701,055 will be used on this
project.
I further agree 10 ensure thai 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
::tj?;C~O
Data \. '5>'-,,\ ,ftS ,
\ .',
VALIDATION: ~7J /
RECEIPT NUMBER _\ \0 v'?'/
DATE PAID ~t ~ .<-1"1
AMOUNT RECEI":EO n d.. ~ '8 .()l )
RECEIVED BY ~\ rt>..... /
( -
.
ATTACHMENT B1
.B NO. 941110
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
.'
NAME OR COI'lPANY: .Te FFR-E:Y 1)e::""'u,.~
LOCATION: <:;'-19"Z~ ?/"I4 fb~';"Y'\l-\-I;"
\"'60'2-04-1\ - no\"Z-o
DEVELOPMENT TYPE: ,,^p\2- - C:"...p...l'o(Z..1 At:.-61'lIOt-..\
C'A!'-?o",:f PAil E.
BUILDING SIZE: zt,." Z4- I">" 1 LOT SIZE
SQ. Ft.
1. STORM nRA,INAGE (10~?V
IMPERVIOUS SQ. FT. /'2-"'1' X $0.209 PER SQ. FT.
2. SAtllIARY SFWFR-CTTY C ~
NO. OF PFU'S X $43.26 PER PFU -
(See Reverse) -----
3, TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X ~ X $436.19
c
...........
)
~
X
X
X $436.19
X $436.19
$
$
SUBTOTAL (ADD ITEMS 1.2, & 3) $ \C?"'Z-?~
4. SAtllIARY SFWFR-MWMC
NO. OF PFU'S x $17.19 PER PFU + $10 MWMC ADMIN.FEE $
(Use PFU Total From Item 2 Above)
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
(~
$ 11?2 ?Co
)
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
lOlAI -M\.JMr snr.
5. ADMTNISTATTVF FFFS
BASE CHARGE (SUBTOTAL ABOVE) X .05
C7~)
---- ---
1~~Lut
~..."...;.,' PI':
SDC.Coordinato~ ..
Date: ':?,II? /<=>t r;
IQIAI snc
$ I c:. "I "!!-
B2,SDC .