HomeMy WebLinkAboutPermit Building 1993-9-28
61~ _ . ~
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
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.
~p 'I'll
JOB NUMBER
9~\41 s
225 Fifth Street
Springfield, Oregon 97477
LOCATION OF PROPOS1D WORK' ~ 3.7)
ASSESSORS MAP' \~n~()C{\ ~ TAX LOT: (7)tECO
LOT' Sd-. - BLOC;' t SUBDIVISION: (irldQ(\T&ifYlL<SL.
OWNER:\. nlO~. (:\n\t1DbU'1_t..4d PHONE:-l')<Aq~ 1'lldL..
ADDRESS:'0_b \~\ ,--~")UV ~&(r'd . { .
CITY' 91 ~C\~~ (j STATE: 1\2r.QC\~ ZIP' q l10L
(\. -
DESCRIBE WORK~ ;\ 'f\f). f\ L~<t\(){\f\ Q ~ c:t-- CD JU.rrf2.,T-:
NEW REMODEL ADDIBN DEMOLiSH O~E~ . -
CONST.
CONTRACT9f1'S NAME AD~~\r CONTRACTOR # EXPIR,E"A, PHONE
GENERAL: b.~\Q(\~~:'1i~ \ . .\ ~h~0~\S:_J lo\tNtr7 6'.1~o~q.0~~2,
PLUMBING' . .. ( nlM-tt .5 'l q4 (,xq .f)~(/)Z ...
MECHANICAl'
ELECTRICAL' 1-!fJi:.lTfIt::.l FLu-::n:.IG
QUAD AREA: 4~
# OF BLDGS' I'
OCCY GROUP: ~~-ttv\
# OF STORIES' \
WATER HEATER: _7- ~
8'6~LU.cl!\""<.'^f, lo?1\?l) \Q..1~~ ,~4\.q,\~)
- OFFICE USE -
LAND USE: ~n
# OF UNITS: \
CONSTR. TYPE: V J..-I
HEAT SOURCE: F f ~
t.J
RANGE:
FLOOD PLAIN'
ZONING CODE:
LD fL-;
# OF BDRMS'
SECONDARY HEAT:
SQUARE FOOTAGE:
I ~4:'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 after 7:00 a.m. will be made the following work day.
o T,pmporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting form
r:::f) Underslab Plu 9 lectrlcall.
\. MechanIcal - Prior over
!Fooung - After trenches are
excavated.
Masonry - Steel location, bond
beams, grouting.
o Foundation - After forms are
erected but prIor to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
o
Underfloor Plumbing/Mechanical
- Prior to Insulation or decking.
o
Post and Beam - Prior to floor
Insulation or decking.
o Floor Insulation - Prior to
decking.
~sanlta.-y Sewer - Prior to fililng
9.....trench.
u-:Rstorm Sewer - Prior to filling
~trench. .
. .J()water Line -"prior to fiillng
~ ~rench.
o Rough Plumbing - PrIor to
cover.
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
o Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtai n permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
D Framing - Prior to cover.
o Wail/Ceiling Insulation - Prior to
cover.
o D.-ywall - Prior to taping.
o Wood Stove - After I~sta"ation.
o Insert - After fireplace approval
. and Installation of unit.
~curbcut &: Approach - After
. forms are erected but prior to
placement.of concrete.
~/
Idewalk & Driveway - After.
excavation Is complete, forms
and sub.base material in place.
o Fence - When completed.
~ Street Trees - When all required
r trees are planted.
o
Final Plumbing....;. When all
plumbIng work Is complet.e.
D Final Electrical - When all
electrical work Is complete.
'.
o Final Mechanical - When all
mechanical work Is complete.
~f/nal Building - When all
required inspections have been
t approved an1l. bUildin~
completed. \.:OJ\....~ 1 ,
o Other
MOBILE HOME INSPECTIONS
lfi Blocking and Set.Up - When ail
( ~ blocking Is complete.
~Plumblng Connections - When
home has been connected to
water and sewer.
?1Electrical Connection - When
blocking, set-up, and plumbing
Inspections have been approved
and the home is connected to
the service panel.
mal - After all required
inspections are approved and
porches, skirttng, decks, and
venting have been installed.
Lot faces ,
Lot sq. flg.
----1...
Lot coverage
Topography
Total height
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
1ft7<X
~tf\1
o '\~
Total Val ue
Building Permit Fee
State Surcharge
Total Fee
Lot Type
X Interior
Corner
Panhandle
Cul.de.sac
X $/SQ. FT.
.
.
I, IS 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
'HSE'GAR'ACcl
I
I P.L.
IN
Is
Iw
~
APPROVED'
= VALUE Q I
4-9, r/Y).
~"IO ILoC\Lpca
~Q 1'C\
. l=)S. <i\G\ (0
Ul'i5C\l11") !o~.5()
,0..4 ~
II \ ~3
N'
FT.
FT.
FT.
Fu mace
MECHANICAL PERMIT
(C)
Total Charge
Exhaust Hood
Vent Fan
(A)
Dryer Vent
Wood Stovellnsert/Flreplace Unit
N'
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk I 00
Curbcut (31
Demolition
State Surcharge
fl
fl
Total Miscellaneous Permits (E)
SYSTEMS DEVELOPMENT CHARGE (SDC) *'
. (B) 1j. 'Z II (" C?!..
PLUMBING PERMIT
ITEM
FEE
~S~
~ S .DUO
f\ 0
(yS.
')~OU
..3 . f'LS
()b.r)~
o
\C6~
a1). tV
5.a~
IY.U]
\"t.W
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D. and E Combined)
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition th the said
construction shall, in all respects, conform to Ordinance
adopted by the Cily of Springfield ncluding the
Development Code, regulating ttle con ruction and use of
buildings, and may be suspended revoked at any time
upon violation of any pravi 'on of said ordinances.
Plan Check Fee: ,,,-,
Date Paid: .\:": '\('
Receipt Numb
.,..RIans Revi ewed By
Date
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Systems Development Charge is due 'on all undeveloped
properties within the City li~its which are being improved.
ADDITIONAL COMMENTS ,
~~ H l\ (\J:::)\ oi Q H~)Lrt.PL( 'YO 0 .r )
'- ~+-C \~.qlon
\_~MOJL G010 / \qr,q
.../). I ~ ( (-4ocx-9-- \'0 "" t.~
By signature, I state 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 thai 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
o the site at all times during construction.
natureJ_J/~.u;........ '&. NaA.1~,^
c::y . 2.8 ,Cj3
VALIDATION: \'f\A In
RECEIPT NUMBE, 1 1\ ftLl
DATE PAID '--"'\ .fn4 ~
AMOUNT REC~\ I ~ - - )-
RECEIVED By~R
r
... ""-.-..
.....>-...""".
.
.08 NO. Q?IL\-2S
CITY OF SPRINGFIElD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: ~I \ e.L Go LDSBLlI2.Y
LOCATION: ~:?B ~\"'- - \~02...0~'Z-? - 0 \<iSoo
DEVELOPMENT TYPE: LP~ - t-lE-W N\Pr~Ll. I-l.c> M:.fO
..tOMe -:'10... CM4' DW
BUILDING SIZE: 'Zfl~IDI.I"'.5"\.. \'1.<;~1-' .\~V...o LOT SIZE
SQ. Ft.
1. STORM DRAINAGE
IMPERVIOUS SQ. FT.
-z.q'-t,
X $0.203 PER SQ. FT.
~?qe2.<1:.)
'- ...----
2. SANITARY SEWER-CITY
NO. OF PFU'S
,(See Reverse)
3. TRANSPORTATION
IS
X $42.08 PER PFU
(;'5ro.fl)
"- ......-/
NO OF UNITS X TRIP RATE X COST PER TRIP
X
X $424.31
~"'Ze "'6::)
'- ...-/
$
$
\
X 1.01 X $424.31
X X $424.31
4. SANITARY SEWER-MWMC
NO. OF PFU'S I 'to x $15.125 PER PFU + $10 MWMC ADM FEE $ 2&"2 '2.2-
(Use PFU Total From Item 2 Above)
$ '=>1 'Z~
MWMC.CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL-MWMC SDC ~
'- ../
SUBTOTAL (ADO ITEMS 1,2,3 & 4) $ '2.0 \? ~
5. ADMINISTRATIVE FEES
. BASE CHARGE (SUBTOTAL ABOVE) X .05
~~. _O~ c.k- "1/oz,(J /q,~
. :U Kip Burdick '/
SDC Coordinator
~ 00''':-)
........ ...-/
TOTAL SDC $ -z. II <0 o~
..r' .'
J
..
.
o y'y'i!I.!!!!!!~!!~
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Job No. CJ314tLS.
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME~~' b.D\[\JJ'\:)\D\ to. PHONE: LD~q-f(r'\\j)~
ADDRESS: cjf)\4~.\ \ ~l).-J,CPRJI bX\J STATE:~ZIPg'J4(j])
(j 0
LOCATION OF PROPOSED BUILqI.,NG SITE: ~111 ,'Il)j /l,
Street Address if Known: 5Ll~) I J' .rn~ 7 J A~
Plan Name: Grlcltn'~'(f(\(O Tax Lot Number: \m::\'[)~Q::\ ()\fY"L)
di
1. DEVELOPMENT TYP~ (Check appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the back.)
;;<
A. Sinl1le Familv - Detached
Single Family home
I
Manufactured home not in a park
$ 4ffJ.oO
NO OF UNITS
X $400 PER UNIT =
~ B. Sinl1le Familv - Attached
NO OF UNITS
X $370 PER UNIT =
$
C. Multi-Familv Aoartment
NO OF UNITS
X $277 PER UNIT =
$
D. Manufactured Home Park
NO OF UNITS
X $280 PER UNIT =
$
WPRD SDC
.A",^ 00
$ -n ^--J .
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)
$0
$ 4{J() pC)
~~~ D
Community Services Di~Sf
City of Springfield
C\ / p)~ /l~
Date
stGFIELD ....
~
..
..
The following projoct as submitted.~as the followin
zoning, and does not require specifIc land use
approval.
225 FIFTH STREET ~.17 /'
SPRINGFIELD, OREGON 97477 Zoning \IV''''-
INSPECTION REQUEST: 726i'i~t~69ti, 1.SLC,?:>
OFFICE: 726-3759 1~1~
Aulhorizs<i Sign&ture~. ~.' 'J9*:?:':::::B rEE SCHEDULE BELOV
1. ~~I9li I S AL nON )
\.. 'J L..l ..."""l J n A.
J~Aq~~~6 bf'60()
~P~:~~~t~:~fe:bl: ~~ire
if work is not started within l80 days
of issuance or if work is suspended for
180 days.
ELECTRICAL PERMIT APPLICATION
q3\~
City Job Number
New Residential-Single or
Multi-Family per dwelling
Service Included:
uni t.
Items
Cost
Sum
$ 85.00
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
$ 15.00
~
Pr)
$ 40.00
Services or Feeders
Installation, Alterations
or Relocation:
B.
2. CONTRACTOR INSTALLATION ONLY
Electrical contract~ 0 y\*~
Address ~ ~ lJ.'"). M ~
City h-~t.NL- Phone laq. \~
Supervisor Llcen~e Number ~tL\~ .
\D. \.c\S
lo3~f)
\ Q. .@.1) .Q3
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
200 amps or less
201 amps to 400 amps
40l amps to 600 amps
60l amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
Expiration Date
..
Temporary Services or.Feeders
Installation, Alteration or Relocation
C.
Constr Contr. Number
$ 40.00
$ 55.00
$ 80.00
see "B" above
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
Expiration Date
Signature of Supervising Electrician
~~
Owners Name:.1\; oQ brldlltJtt}\ A. ~ D.
Address~tJ \~ \ t\lf'.\ \.qCC \\)
City ~ UQJ,\Q . Phone~?A-/}1~
OVNER ~STALLATION
Branch Circuits
New, Alteration or Extension Per Panel
$ 35.00
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit I
$ 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 c9rJ . cD
5% State Surcharge "+. i (.)
TOTAL. ja/,f n. if )
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
r~.- --------
'--Z'~
Y In. +\'~
DATE~-~----q~~7 r
RECEIPT I:
RECEIVED BY:
.