HomeMy WebLinkAboutPermit Building 1992-4-2
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726.3759
LOCATION OF PROPOSED WORK'
ASSESSORS MAP'
LOT: .:#..s 7
OWNER'
h J"..... 6 /..;o.....~
..J HJ... M.e fo(,,,,- ~-
ADDRESS:
CITY: F "---V--.. I
DESCRIBE WORI<'
s-":::'~ .
NEW
x
REMODEL
CONTRACTOR'S NAME
GENERA" f{.L. B If.-..-
PLUMBING: r:.~ :r;:.'. 6"7U:;j
MECHANICAL: ~~ d~~
ELECTRICAl - ~ r.P...-IJ}
(J
\R-\\ '1.0
. OF BLDGS' 1\
OCCY GROUP \.z~N\
. OF STORIES: _' -
T-.-/
QUAD AREA:
. WATER HEATER'
.
.
{{W3fJ!-
SPRINGFIELD
8d:l.
.::)"...uN< tic . C,,'-<--.....f--
JOB NUMBER
225 Filth Street
Springlleld,Oregon-97477
TAX LOT:
SUBDIVISION: Ro..!!,""" G!s- {. 1..,-
7...d.. .Q1"~tal
PHONE: ~'-I ~!':- J U b
ZIP:
t:7l/0 (
BLOCK:
STAT~' 6}-L,,,,--./
V
ADDITION
DEMOLISH
OTHER
ADDRESS
.J-t;'~ J-- }1-.R;t,,;
c....~.1J
CONST.
CONTRACTOR'
.5'''' off 9
PHONE
'fd S"J17 Go
it 'f:.J//</0
REQUIRED INSPECTIONS
rY1 Rough Mechanical - Prior to
~ cover.
~ Rough Electrical - Prior to~
~ cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power. .
D Fireplace - Prior to facing
materials and framlng.lnsp:
C!l Framing - Prior to cover.
r:;;;'I Wall/Ceiling Insulation - Prior to
lA.J cover.
141 Drywall - Prior to taping.
,
D Wood Stove - After installation.
o Insert - After fireplace approval
and Installation of unit.
[l] Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
r;.7l Sidewalk & Driveway - After
W excavation is complete, forms
and sub-base ~aterlal In place.
lZl Fence - When ~ompleted.
~ Street Trees - When all required'
trees are planted. t.... .. .
EXPIRES
fo/<13
~/9 L-
<<1'13
71,,2...-
1 V/_()OD Z--
., "l...-,H Z L-
dOll ..;
.51"70 J<J /'If4 C. ,,)cJLyc)
'7tf7fD? ,hI s..J..a.. 0 -, -3N.5G.
- OFFICE UfE -
LAND USE: \ \ \ \
. OF UNITS: \ J
CONSTR. TYPE: V f\j
HEAT SOURCE: ~~
y./
RANGF'
FLOOD PLAIN: \ D t)
ZONING CODE: .I '- ~
. OF BDRMS' L\-
SECONDARY HEAT: . y'f-J
SQUARE FOOTAGE: & XX~_
To request an inspection, you must call 726-3769. This is a 24 hour recording. All inspections requested befC?re 7:00 a.m. will be
made the same working day. InspectIons requested after 7:00 a.m. will b!3 made the following work day.
~ Temporary Electric
. 0 Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumbing/ElectricalJ
Mechanical - Prior to cover.
[JJ Footing - After trenches are
excavated. .
o Masonry - Steel location, bond
beams, grouting.
r:;l Foundation - After forms are
LA.J erected but prior to concrete
placement.
[2l
Underground Plumbing - Prior
to filling trench.
G(]
Underfloor Plumbing/Mechanical
- Prior to Insulation or ~ecklng.
~
Post and Beam - Prior to floor
Insulation or decking.
f71 Floor Insulation - Prior to
L4J decking.
r7l Sanitary Sewer - Prior to filling
~ trench.
rh7I Storm Sewer - Prior to filling
lL.\-J trench.
r:vl Water Line - Prior to filling
V4-J trench.
IAJ Rough Plumbing - Pr!or to
i ~over.
IZJ Final Plumbing - When all'
plumbing work is complete.
"rYl Final Electrical - When all
IL..\-J electrical work is complete.
[2J Final Mechanical - When all
mechanical work is complete.
I
rVl Final Building - When all
lL\-J required Inspections have been
approved and building is
completed.
DOther
MOBILE HOME INSPECTIONS
D Blocking and Set.Up - When all
blocking is complete.
D 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 installe;d.
Lot faces .s o..TI-. Lot Type. Setbacks . THE PROPOSED WORK IN THE
Lot sq. Itg. ~ ~ Interior I P.L. HSE GAR ACC I HISTORICAL DISTRICT, OR ON
IN I THE HISTORICAL REGISTER?
Lot coverage ~ Corner ZI.9:~ If yes, this application must b Igned
p-~ Is I&-i-#P. I and approved by he 1St rical
Topography Panhandle Iw I I Coordinator prior to p It issuance.
,~ 71
Total height Cul-de-sac
IE I~l I I APPROVED:
BUILDING PERMIT
ITEM SO. FT.
Main ;.1.;1(.0
X $/SO. FT.
X 37, fO
1'-1</./0
VALUE
~.5&.r<{
.-
f? ~SS'"
Garage
(qJ-Y
Carport
-.!i.iSt) 't
. -
41/ J<i _ oe:-
zttJ. 9.0
Y-::J~~
SYSTEMS DEVELOPMENT CHARGE (SD~i 18
(B) -t"Z:Z:2-9 :--
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s) NO :::2
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
~tC>
Mobile Home
~~Z;;cWCe
/~-
/A:7. en:>
gSc>
/?R.. ~
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
6-~
l.f. So
q.-=-
/6: -e>
'"3. -=>
Furnace
Exhaust Hood
Vent Fan
NO -:;J~ ":3
CWood Sto>jY Insert/ Fireplace Unit
Dryer Vent
Mechanical Permit
?7-,~
/~. CSl:>
/.8}5
t./ '9. 3P.
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk ..sgf? It
Curbcut ~ It
D.a.......~:::: _.. r~#cc \~OO
"2::z..~
/q. --5"?>
~~
State Surcharge
Total Miscellaneous Permits
~:2. -:zs-
(E)
TOTAL AMOUNT DUE (excluding electrical) ~3S.. 76
(A, B, C, 0, and E Combined)
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 of Sprlnglleld, 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:;;' 1/. 10 .
Date paid:l~' \ ~~
Receipt Number:~ ~
R~ By: . ( .I'!!)
,/" ~""?-"""""" ~.,-..,
~,P6'1'leviewed ~ .. ~
"7--2 ?-7'"2....
Date
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
rcl,\fl4 :
~
. ;:f7~ .I
\ G(' {(O
By signature, I state and agree, that I have carefully examined
the completed appllcallon 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 sitZSJ;at mes during construction.
~ #/:-
Signature ,:)---, - .......
Date
_~//3 /~ L-
VALIDATION: A f) III
RECEIPT NUMBER I~I
DATE PAIP ,4, 2-. L.f ~
AMOUNT REtf/iE '-:V~~ ~ . G::>/
RECEIVED B (j Y1 )
I -
t
JOB NO. ""'2-0"""+
CITY OF SeINGFIELD SYSTEMS DEVELOPM. CHARGE
WORKSHEET 1
, (COMMERCIAL &. RESIDENTIAL)
NANEOR COMPANY: Fv-rv!(.e 1:> ~Me."
LOCATION: . ~~'l- :!p....a,.IF--r-re CotJ~T
DEVELOPMENT TYPE: Loe- - ME:.W -:'"FR
BUILDING SIZE:
1. STORM DRAINAGE
IMPERVIOUS SQ. FT. ~, c..., X SO.186 PER SQ. FT. ~ fOO ~
(See Reverse For Runoff Coefficients If Actual Imperv. :Area Is Unknown)
, LOT SIZE
SQ. Ft.
2. SANITARY SEWER-CITY
NO. OF PFU'S 20 X S38.55 PER PFU
(See Reverse To Determine Total PFU'S)
$ 11\ O-,!
3. TRANSPORTATION.
NO OF UNITS X TRIP RATE X COST PER TRIP
\
X \. oce;. X $388.61
$'~6...t; .
~
X' .. X $388.61
.""-' '.', ",.- X~ ,'--=, X $388.61 ,....,
(S~~ Attachmen~ ~ To, Determine Trip Rates) ,
, .... , " "" ." SUBTOTAL '(ADD ITEMS 1.2,
$' -
. ,
.. ',.
$ -
&. 3,.: S ]B~l ~':"-
4. ADMINISTRATIVE FEES
'BASE CHARGE (SUBTOTAl ABOVE) X .05
$ Cf"'::>~
TOTAL-CITY SDC $ 19c::.Lf~
5. SANITARY SEWER-MWMC
NO. OF PFU'S
Zo
"'....0<:..,-_
.x S13.25 PER PFU + SID MWMC ADMIN.. FEE $ v I ~
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
\:::::"'-,,~&..
.----(f Kip Burdick
SOC Coordinator
~ /" /0,'1-
/
S
TOTAl-MWMC SDC $ 1.1S<>.e
TOTAL SDC S '2."2-'2-9 ~