HomeMy WebLinkAboutPermit Building 1994-10-24
RESIDENTIAL
PERMIT APPLICATION
Inspections: '726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP' ill"\"<.. ~~
LOT'
.
R4c
1'-1
~lk. %_0..
- \
BLOCK'
OWNER: Ck-" ~"4>....e.. u.uA-"f\
ADDRESS:' ~~ ~\\"'l \),l.,&
~~~M~"l&
, ...)
CITY:
.
q 41 4t)k>
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
TAX LOT'
'00'-/1"\(")
SUBDIVISION'
. PHONE: rl./."- d.~ql"\
STATE: . 012 ZIP: -="'U ..........
DESCRIBE WORK: ~
'-{'v.L..',V Tb
ADDITION \I
axi~('\e.
......
. DEMOLISH
~..t'\t""\~
NEW REMODEL
OTHER
CONTRACTOR'S NAME ADDRESS
GENERAL: C.j.""M.""~~\.~ ~T"\..
, .
PLUMBING: ~ f>ll.""LI:J
,
. Sacs b~'
~rO. \,
\)AI\4I~~
CONST.
CONTRACTOR #
,Q;;v.,..4
EXPIRES PHONE
~" ~.-~<;.\Q
Cl~",,-.,~~.~
MECHANICAl'
ELECTRICAL:
o~"''' Q"C".
QUAD AREA:
# OF BLDGS:
OCCY GROUP:
\Qt\") I
\
'R~
# OF STORIES:
WATER HEATER'
k:\.... . LW\
I' .
~ ',.
.' .
_llJ':./AO
-:t.4~-S3C\S"
FLOOD PLAIN'
ZONING CODE:~
# OF BDRMS'
SECONDARY HEAT: .
SQUARE FOOTAGE:
~lo
- OFFICE USE -
LAND USE:
III \
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 8.m. will be made the following work day.
REQUIRED INSPECTIONS
D Temporary Electric
D Site Inspection - To be mado
after excavation, but prIor to
setting forms.
D Underslab Plumblng/Elactrlcalf
Mechanical - Prior to cover.
~otlng - After trenches are
excavated.
D Masonry - Steel location, bond
,beams, grouting.
rVl Foundation':"" After forms are
~ erected-but prior to concrete
plecement.
D Underground Plumbing - Prior
to filling trench.
rv1 Underlloor Plumbing/Mechanical
'-f>' -.Prlor to Insulation or decking.
f\T1 Post and Beam - Prior to floor
L..:\-l Insulation or decking.
r::rl Floor Insulation - Prior to
'-+' decking.
~ Sanitary Sewer - Prior to filling
LU trench.
D Storm Sewer - Prior to filling
trench.
rvl Waler Line - Prior to filling
1 trench.
rYl Rough Plumbing ~ Prior to
L...p=J cover.
# OF UNITS: .\ ..)
CONSTR. TYPE: ~L
,
HEAT SOURCE:
RANGE:
rvl Rough Mechanical - Prior to
L...f::.J cover.
rY1 Rough' Electrical - Prior to
~ cover.
~~, 1 \
D Electrical Service - Musf'be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
rn Fra~lng - Prlor:to cover.
D Wail/Ceiling Insulation - Prior to
cover.
[Xl Drywall - Prior to taping.
D Wood Slove - After I~sta"atlon.
D Insert - After fireplace approvel
and Installation of unit.
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sidewalk & Drlveway.- After
excavation Is complete, forms
and sub.base material In place.
D Fence - When completed.
D Street Trees - When all required
trees are planted.
!Xl Final Plumbing - When all
plumbing work Is complete.
. .
r7l Final Electrical - \lV.hen all
L..p..I electrical work Is complete. C
IYl Final Mechanical - When all
~ mechanical work Is complete.
00 Final Building - When all
required Inspections have been
approved and building Is
completed.
DOthor
MOBILE HOME INSPECTIONS
D Blocking and Sat.Up - Whep all
blocking Is complete.
D Plumbing Connections - When
home has been connected to .
water and sewer.
D Electrical Connection - When
blocking. set.up. and pluI'Qblng
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 faces
lot ~yp.
Interior
lot sq. Itg.
Lot coverage
Corner
Topography
Total t;elght
Panhandle
Cul-de.sac
'}:r ': , ,;.;, . ':" ." ',l ~ ;:.,ii :~'.~\N. ~~ j'.
Setbacks.
~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.
h~L HSE GAR ACc'I
IN I
Is I
W I
E I
BUILDING PERMIT
ITEM sa. FT. x $/SO. FT. - VALUE
fv1ain
Gatage
Carport
Total Value
Building 'Permit Fee
1..\'!l o\:r.~
State Surcharge
Total Fee
(A)
"
t!it~, ?l'f1P
~,~
.. S.1I!l.
<01,-
.
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
_~ ~ ;1 i'"
PLUMBING PERMIT
ITEM
FIxtures
.
~
Residential Bath(s)
N'
Sanitary Sewer
FT.
Water
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
\.~O+ '!."a
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
\
Wood Stovellnserl/Flreplace Unit
Dryer Vent
Mechanical Permit
. Issuahce
State :Surcharge
Total Permit
."'IS". "r~ ~
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
Slate Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excludlng'electrlcal)
(A, B, C, 0, and E Combined)
FEE
'!.o. ""
~<.?~
~~
6~.~
''1
"S . c.u. -
lS.~
\O.l;,b.
\.~
M.:l&
c:z
,
\S'-\.~~
APPROVED'
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 Clty.of Springfield, Including the
Development Code, regulating the construcilon and use 01
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plan Check Fee: ~ ~
Date Paid: -q:..1f >j 4:'
ReceIPt'~umber: ~o
Re~ved By:
b "
Plans evlewed By
lG/.!lLJ/c;~
~~.
Systems' Development Charge is due on all undeveloped
. properties within the City limits which are being Improved.
. ..
ADDITIONAL COMMENTS
..:b~~ ~ \~ \)l,.:" \
~ ~ Jl"~'\\~~
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 Ordlnanc~s 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 site at all times during construction.
Slgnatun'"
Date
VALIDATION:
RECEIPT NUMBER l Vj\ ill
DATE PAID \0 ..1J-\..q '1
AMOUNT RECEIVED ~7j.\, <m
n. ,1iVIAY
RECEIVED BY
.. Al I ACHMENT B1
__. .. JOB NO. 9-fE/4S'C.
CITY OF SPRINGFIELD SYSTEMS DEVELOP~ CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NftJ1E OR COMPANY: ()/fA'1 J/~
LOCATION: 'l'"-1a k#~ Ah-/
DEVELOPMENT TYPE: ~ ~ hat.. - 'd'
A?,P,fOl<.
BUILOING SIZE: 5'" x r /tVj~ ) I.OT SI7F
SQ. Ft.
1. STORM nRATNAr,F
IMPERVIOUS SQ. FT.
-'10
X $0.209 PER SQ. FT.
"....-- ...,
$( %.36 ;
...... --
2. ~ANTTARY SFWFR-CTTY
NO. OF PFU'S .____~ ~:lx $43.26 PER PFU
(See Reverse) ~ ~ f. U)
3. TRANSPORTATTON
$~
/
NO OF UNITS X TRIP RATE X COST PER TRIP
X X $436.19
$
-XM-
/
X
X
X $436.19
X $436.19
$
$
SUBTOTAL (ADD ITEMS 1.2. & 3) $ 0.3 ~
4. ~ANTTARY SFWFR-MWMC
NO. OF PFU'S x $17.19 PER PFU + $10 MWMC ADMIN.FEE $ ~
(Use PFU Total From Item 2 Above) ~
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
IOlAI -MWMC snl;
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
$
$
$ 8'.36
5. AnMTNTSTATTVF 8EES
BASE~HARGE (SU~TJTAL ABOVE) X .05
~ 4\( Date:
~sacryc~nig. P.E~
/' C:o oordi nator
~.~,].)
-.
~- 3cJ-77'
IOlAI snc
$ %. 7 'i'
B2.S0C .
.
The. following projec1 as submntod h~s tho folio ~ .
225 FIFTH STREET ~~~';~~al.nd does net requiro "peeiflG lon'E~CTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97471 . Lo /J
INSPEctION REQUEST: 726-3769 ZOning {L-
OFFICR: 726-3759 Dote 11-<(;' -C14
f l~' COHPLETE FEE SCHEDULE BELOV
1. J.l.lCJ.TMlN f!! ~ifALLATI6WhOrIJ:ed Signature IJY\-'--'
?'St:.tl) ~ t. A. Nev Residential-Single or
O. Hulti-Family per dvelling unit.
. LEG~E.SCI!.!PTION rv>..-1,,~ Service Included:
-' '7 O~ 1<+ u J"1t' '=-.' Items Cost
Jr~1i~(l~~
Permits are non-transferable and expire
if york is not started vithin 180 days
of issuance or if york is suspended for
180 days.
I
2. CONTRACTOR INSTALLATION ONLY
,
Electrical Contractor--DlXnN ~I ~rTRTr
Address
1130 BAILEY HILL RD #24
City FIIGFNF Phone ~LlLl-~~a.5..-
Supervisor License Number
36145
Expiration Date
10/1/95 ..
Constr Contr. Number
..
li6R94
Expiration Date
~/?~/Q~
Signat~ro of Supervising Electrician
. . s!Jvxf_ ~
Ovners Nalle (Qif"l %U")'n. )
Address B4D ~
City. ~ Phone ct7.2.SC()
01lNER INSTALLATION
The. installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
DATE: ---------~---1~1$~C1r~---~
RECEIPT .: \ nl:-. , ,,,", _ ') \ c;-..~
RECEIVED BY: V l VulA.....Y" \-.....
'City Job Number
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Hanuf'd Home or
Hodular Dvelling
Service or Feeder
B. Services or Feeders
Installation, Alterations
or Reloca t ion:
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
~,t?
Sum
S 85.00
$ 15.00
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or'Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000
D.
Branch Circui ts
$ 40.00
$ 55.00
$ 80.00
volts see "BII
above
Nev, Alteration or Extension Per Panel .
One Circuit \ $ 35.00 ~
Each Addi tional
Circuit or vith Service
or Feeder Permit S 2.00
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
not included)
$
$
$
$
~S.OO
~
3'1.fs()
40.00
40.00
20.00
36.00