HomeMy WebLinkAboutPermit Building 1994-12-15
OWNER: \'J\~\~~ ~~'t._'.
ADDRES~' '\)r'\ 9,i'Y,~,-, ~\ Q -~ '
TJ. ")()- Q.X\..L
~
DESCRIBE WORt<' ,Q.. '\=" Vo [\\00 f\l'Q..J
NEW f- REMOD~:
( . , ,
CONTRACTOR'S NAME .l\ ...^~ ADDRESS
GENERAL:(\C\.l\OG~, WJ\\ lQl)J,
PLUMBI~G: ~\~
MECHANICAL: ,~
ELECTRICAL: ~ ~J
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Ortlce: 726.3759
LOT'
CITY:
QUAD AREA: ~<....{=;
· OF BLDGS' \,
OCCY GROUP: t\~~
· OF STORIES: . ~
(1
WATER HEATER:
.
BLOCI<'
.
C\4 \447
JOB NUMBER
STATE: "
11\ \) ~ t7r\
ZIP: CJ\0f\.QS
f"V( R~ugh Mechanical....:. Prior to
~ cover.
~ Rough -Electrical - Prior to
~ cover.
f'V'f Electrical Service - Must be
~approved to obtain permanent
electrical power.
f'V'( Fireplace - Prior to facing
~ materIals and framing lnsp.
~ Fr8~lng - prior, to cover.
I
~ WalllC'elllng InsJlatlon - Prior to
~cover.
D Underground Plumbing - Prior K7'1
to filling trench. ~ Drywall - Prior to taping,
1'\:7( Underllo~lumbhJ~echanlc~
~ - Prior tvlh::JulBtjOn ur Ut:CKlng. D Wood Stove - After Installation.
~Post and Beam - Prior to floor
)C>..t Insulation or decking,
ADDITION
DEMOLISH' 'j
'OTHER
CONST.
;-> CONTRACTOR'
? 111.8
~~h
, 'J!{oPR4
/
- OFFICE USE -
LAND USE: \ \ \ }
· OF UNITS: \
CONSTR. TYPE:---1LN
HEAT SOURCE: ~ G
RANGE: G .
EXPIRES
/./S.q""
Shq(~
I~ '~::\~=4
0'?~'Y~
PHONE
FLOOD PLAIN'
ZONING CODE: --.U- '1 '--'
. OF BDRMS: L\-
SECONDARY HEAT:' f\J
SQUARE FOOTAGE: a~ (p
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 ofter 7:00 a,m. will be made the following work day,
REQUIRED INSPECTIONS
~emporary Electric
t':7f Site Inspection - To be made
~ after excavation, but prior to
setting forms. (S t}1 t )
D Unde,slab Plumblng/Electrlcal1
'Mechanical - Prior to cover,
r<;;>( Footing - After ,t. renches are
~ excavated. "
D Masonry - Steel location, bond
.beams. grouting.
~Foundatlon - After forms are
L..6.llerected but prior to concrete
placement.
K7f" Floor Insulation - Prior to
~ decking,
0;;;r Sanllary Sewer - Prior to filling
~trench.
~ Storm Sewer - Prior to filling
~ trench.
~Water Line - Prior to filling
~trench.
!\/rRough Plumbing - Prior to
~cover.
D Insert - After fireplace approval
and Installation of unll,
I':7f Curbcut & Approach - After
~ forms are erected. but prior to
placement of concrete.
!t;;rSldewalk & Driveway - After
)6.J excavation Is completa, forms
and sub-base material In place.
D Fence - When completed.
/r"?'nstreet Trees - When all required
~trees are planted. .
r'V'f Final Plumbing - When all
~ plumbing work Is complete,
, ,
~ Final Electrical - \Nhen all
electrical work Is complete. (.
~Flnal Mechanical - When all
~mechanlcal work Is complete.
R71'"Flnal Building - When all
~ ~equlred Inspections have been
approved and building Is
completed.
;;8r Other _4A-S l./~
MOBILE HOME INSPECTIONS
D Blocking and Set.Up - When all
blocking Is complete,
D PlumbIng Connoctlons - When
home has been connected to
water and sewer.
D Electrical Connection - When
blocking, set.up, and plu"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.
,'~ . " '" ,; ;....';.~:~.\f:~.i- -tits THE PROPOSED WORK. IN THE. '
Lot faces 4- Lot TYP. Setbacks,
Lot' sq. 'Itg;' , tf!::SS"D v-'Interlor !P,L, HSE GAR Acc'l HISTORICAL DISTRICT, OR ON
IN I 'THE HISTORICAL REGISTER?
Lot coverage ~o Corner j~ II yes, this application must be signed
$,7?.. Is I and approved by the Historical
Topography Panhandle Iw I Coordinator prior to permit Issuance..
Total ~elght 2~,S" Cul.de.sac /B /6
IE /2- I APPROVEr>' '
$/SQ, FT. a VAWE
a\D'?O ffim,
\~,\l)" ' _~~
l
~
:'v~. 2.';
C +1 ;~-~
S5Z f:S
SYSTEMS DEVELOPMENT CHARGE (SDC)
$23?1.."
"
Total Value
Building Permi I Fee
Stale Surcharge Z$,81+-1S':rtf
Tolal Fee
(A)
(B)
PLUMBING PERMIT
ITEM
Fixtures
.
Residential Bath(s) N' ~
Sanitary Sewer FT,
-Water! FT.,
Storm Sewer FT,
Mobile Home
Plumbing Permit
State Surcharge
q.'" + 5,76
(C)
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
4.
Wood Slove/lnsert/Flreplace Unit
Dryer Vent
~A5 iJu..~;fA),<{
Mechanical Permit
lssuahce
State:Surcharge j,S"3 -f-. '12.
Total Permit (D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
7/
.
It
Curbcul
2/0
II
Demolition
State Surcharge
TOlal Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, Co 0, and E Combined)
FEE
-J-'7z.f"Q
/-S:.{!
-2,1:)7. ~ I
c".o ..
4,5"0
/2. ,0-1>
3<:t-d
_C),CO
_-:?tJ.S'O
/0."'0
~ -IS
4'2.'S"
:2.tJ, ,"S
/::1.., ,'10
31-,~S
_3??~S
BUILDING VALUE, PLAN CHECK,
AND BUILDING PERMIT" ,
This permit Is granted on the express condition that the said
construction shall;ln all respects, conlorm to the Ordinance
adopted, by the ',City ,of Springfield, Including the
Developm'ent C'ode, regulating theconst;uctl'on and use 01
buildings, and may be suspended or revoked at any time
upon violation 01 eny proviSions of said ordinances.
Plan Check' Fee: ~~' ~ 'qzr
" . ")1: } 1 ,nl').
Date Paid: 1_
Receipt Number' " ~ "!l~
Rec;0 ~I,~"
Plans Pievle~
"
, , '/~/''?,
, . Date '
J
Systems Development Charge'is due, on ,all undeveloped
_'. . ~ f I
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
;
, Jrtt,\,\
\ (M()J/r~ w~J
J
"
-I
~ c\N\9 "1.--: \CH DC)
\~+I'. r05,~')()
(lJ1J1j)(),'do, ~'\~0
\
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certlly 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 Ihe 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 co~strdc~n,
Slgnatu~ 0().U1 10~
I
Date. ( 2-1 W /3-,'4
VALIDATION:
RECEIPT NUMBER /-1Y7fl::<:J-
DATE PAIr> /:2.-y5"-?Y-
AMOUNT RECEIVED 39-.'2.. 4,:'S'~
RECEIVED BY f~~ ~~,
ATTACHMENT B1 -.
. .JOB NO. 9'?/-f<f17
CITY OF SPRINGFIELD SYSTEHS'DEVELOPHENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: ~ ~/t..c.,
LOCATION: ~x8'7 F~
DEVELOPMENT TYPE: 51'~
BUILDING SIZE:
1. SIQBM nRAIN~
IMPERVIOUS SQ. FT. ~1c, '1
2. SANITARY SFWFR-r.ITY
NO. OF PFU'S ' 23
(See Reverse)
3, TRANSPORTATION,
LOT SIZE
SQ. Ft.
X $0.209 PER SQ, FT. ~/S. G~
X $43.26 PER PFU
($ff'?~
NO OF UNITS X TRI~ RATE X COST PER TRIP
X /,~/X $436.19
X X $436.19
(!4-fO. S~
$
X
X $436.19
$
SUBTOTAL (ADD ITEMS 1.2. & 3) $ 1'15'/./3
4. SANTTARY SFWFR-HWHr.
NO. OF PFU'S 23 x $17.19 PER PFU + $10 Mv.'MC ADMIN.FEE $ -905-,:37
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE) 1J~,J3
, IQIAI -HWHr. snc ~j ",.2:~
SUBTOTAL (ADD ITEMS 1.2.3 & 4) $ 2 2.~ d,3 7'
5. AnMINISTATIVF FFFS
BASE CHARGE (SUBTOTAL ABOVE) X .05
.~~ fbl
7~~ ~' Date:
/HaryiH~rmg. P. .
/' SOC cro6rdinator
~3'~?-)
9 -;2. 7-'1'7-
TOTAl sac
$..2 :5 i/. 19
B2.SDC .
FIXTURE UNIT CALCUL.ON TABLE: Number of New FiX_~ Unit Equivalent ~ Fixture Units
(NOTE: For remodels, calculate only the liE! 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 RefrigeratorlWater Station/Etc........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower. Single Stall.,...,....... ,....... ......... '.'..................
Shower, Gang,.... .......'"...,. ,..,..............,........ ...........
Sink: Bar, Commercial, Residential Kitchen....,...................
Urinal, StallIWal1. ,:...........,...,.,...,...,.....,.....,.....,. ,......
Wash BasinlLavatory, Single...................,..,...........
Toilet, Public Installation...............,.. ,........,......,.., ,.
Toilet, Private..,......,............".., ...,........,.",....,...".
Miscellaneous: ,TMv,rt>J!'.s ,S,INk
.<
I
I
s
:?
TOTAL FIXTURE UNITS
UNIT
EOUIVALENT
2
1
2
3
6
2
6
6
1
3
2
lIHead
2
2
1
6
4
..z
~
FIXTURE
UNITS
4
z.
2.
~
12
z~
Based on assessed value, If improvements occurred after annexation date in table,
CREDIT CALCULATION TABLE:
calculate credits sepa'rates.
~Year
I Annexed
Rate per $1,000
Assessed Value
Year
Annexed
1979 or before
1980
1981
1982
1983
19.84'
1985
$3.46
3.38
3.32
3.21
3,06
2.92
2.73
1985
1986
1987
1988
1989
1990
1991
1993
Credit for, Parcel or Land Only If Applicable
3.46 X $ 2S.'l1o
(Rate X Assessed Value)
X $
(Rate X Assessed Value)
Improvement (if after annexation date)
=
=
Rate per $1,000
Assessed Value
$2.46
2.14
1.77
1.37
0.97
0.61
'0.44
0.15
?'?13
~
CREDIT TOTAL ~ $ 'iT'?,/3
.
o yy"i!I!!!!,l!!~!!~
..
Job No. q41111
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
PHONE: ~ .\\\tn
NAME: (!n.nOlilil ~
ADDRESS: \ D(Q,&P' ~\o'2t)-, F ~
STATE:~IP~
-
LOCATION OF PROPOSED BLJILD~A~: r-J. ,.~' , '" ' "
, Street Address if Known: _ I 0 ~~. I i-UY, }
, ' ,
P1"'N,~ ~, ~'" 'o<N"ffi""IID1DZ.2lJ'>SW
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the back'>
A. Single Familv - Detached
\ Single Family home
NO OF UNITS I
..
B. Single Familv - Attached
NOOF UNITS
C. Multi-Familv Aoartment
NO OF UNITS
D. Manufactured Home Park
NO OF UNITS
WPRO SOC
Manufactured home not in a park
$400~
X $400 PER UNIT _~
X $370 PER UNIT =
'$
X $277 PER UNIT =
$
X $280 PER UNIT =
$
$110 ,ro
$Rf
$1Dn~
2. SOC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet.
3. TOTAL WPRD NET SOC ASSESSED (If SDC reduced for Creditl
\iffi) ~ "^ I? )
Community servic~~
\8v \s/Q4
Dale