HomeMy WebLinkAboutPermit Building 1994-5-26
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RESIDENTIAL
PERMIT APPLICATION
.
Inspections: '726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK' & I ~)
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ASSESSORS MAP:
LOT'
BLOCK'
t
q ADl1rJ)
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
TAX LClT: 0A.4{'r)
SUBDIVISION\ID'\\n, J~
OWN~. "~J\ \00 0._ -' ~. \.()0. . ~ - PHONe.
ADD E . () 'L{ JlW, )-.9 rti t1Ino.JI...< 1
CITY _ {YCi~ ' ". STATE: I 1J/~ ZIP:!:J94 51
DESCRIBE WOR~' \. 'n l \'\\ 0 . \\\l\ ~~ '1 ~ C\- C'OJ\ fY')ft.
NEW REMODEL ADDITION' DEMO~H OTHER. \,
CON ST.
CONTRACT~~'~ ~AME _ ('\ ApORESS ' . :---f _:<:N~ACTOR ·
GENERAL:~' \ Lo\ I ')~~ '~..:. ~~ f:::JJS/L
PLUMBIr:iG: \.'\ ,,\. '
MECHANICAL' -
ELECTRICA'\ )( llli.g...lli~
OUAD AREA:
;\'Q.1\0h~
. OF BLDGS:_-
OCCY GROUP: ~:)
\
f....l
. OF STORIES:
WATER HEATER:
- OFFICE US~
LAND USE: \ \~ )
, I"
'. OF UNIT'"
CONSTR. TYPE: V f'J
HEAT SOURCF' Ts
L
RANGE:
EXPIRES ~~NE
~.fl.q~ '-f1fl.5'J1[
*
FLOOD PLAIN:
ZONING CODE: illL
. OF BDRMS' ~
SECONDARY HEAT:
SQUARE FOOTAGE:
To request an Inspection, you must call 726-3769. This Is a 24 hour recording. Alllnspe~tlons requested before 7:00 a.m. will bo
made the same working day, Inspections requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
D R~U9h Mech~nlcal ...:. Prior to
cover.
D Temporary Electric
D Slto Inspection - To be made
after excavation, but prior t
setting fo
~ Underslab Plumbl
Mechanical - Prlo
D Footing - After trenches are
excavated.
D Masonry - Steel location, bond
.beams, grouting.
o Foundation - Atter forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D Underfloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
D Floor Insulation - Prior to
decking.
~sanltary s.ewer - Prior to filling
rench. .'
.
Storm Sewer - Prior to filling
trench. ! ,
~ Waler Line - Prior to filling
( trench. .
D Rough Plumbing - 'Prlor to
~ _cover. , "
o Rough Electrical - Prior'to
cover.
D Eleclrlcal Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior 10 facing
materials and framing Insp.
cRFra;"lng - P~
D Wail/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
D Wood Stove - Afler Ins lallation.
D Insert - Atter fireplace approv~r
and Installation of unit.
D Curbcut & Ap'proaeh - Atter
forms are erected but prior to
placement of coneret,e.
D Sldawalk & Driveway - After
excavation Is complete, forms
and'sub-base material in place.
D Fence,- When completed.
D Street Trees - When all required
trees are planted.. .
D Final Plumbing - When all
plumbing W9rk Is complet,e.
o Final Electrical - When all
electrical work Is complete.
D Final Mechanical - When all
mechanical work Is complete.
~ Final BUilding - When all
required Inspections have been
approved anf\~llgl~'A-
completed. \J)J~Y \
D.Olher
MOBILE HOME INSPECTIONS
MBIOCklng and Set.Up - W~en all
r blocking Is complete.
~P1Umblng Connections - When
home has been connected to
water and sewer.
~Iectrlcal Connection - When
blocking, set.up, and plumbing
Inspections have been approved
and the home Is connected to
the service panel.
~Flnal - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
...
Lot faces
~t'~pe .
Lot sq. Itg.
Lot coverage
Interior
Corner
Topography
Total height
Panhandle
Cul-de'sac
BUILDING PERMIT
I M 1 . SQ. FT. . rx
$/SO. FT.
Garage
c%l 00
Carport
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'" 1 '1 '.., ';'j"'I"'> ~ J, "'iJiJ' iI;L' :~tt
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Setbacks .
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IN
Is
Iw
IE
. " .,
-I. THE PROPOSED WORK IN THE'_ \.
"'HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
arid approved by the Historical
. Coordinator prior to permit Issuance.
HSE GAR Accl
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SYSTEMS DEVELOPMENT CHAI}(ih(iD~) r-..
(B) ~.itt )
___ BUILDING VALUE, 'PL.AN CHECK
VALUE / 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
L!l r ~" I ..... Development Code, regulating the construction and use of
/~ buildings, and may be suspended or revoked at any time
~ /'" upon violation of any prov of saId ordinances.
~~ ~~ Plan Check Fee' /'
~ Date Paid:
Total Value
'.J.O ~ Receipt Number'
Building Perm' u~.~ ,,/
+ 1./ (p ~. q,3 Received By: /'
.. (A)' '-tl )~"3 Plans Reviewed By
+\% (o5~
'~~
ih__
(C) ~,~) ..~
PLUMBING PERMIT
ITEM
Fixtures
Resldentlal.'Balh(s)
'.
N'
. I
Sanllary Sewer
Water
FT.
FT.
FT.
Storm Sewer
Mobile Home
Plumbing Permll
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood StovellnsertlFlreplace Unll
Dryer Vent
M'echanlcal Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
Stale Issuance
State Surcharge
~OJo
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
FEE
I
~SCD'
~~9.I
\ 'SCV
RJ
\ D5.CO
6ln~
,,'=) a:;
I.~.G
TOTAL AMOUNT DUE (excluding electrical) ~
(A, B, C, 0, and E Combined) G:K\Z.,.\o.. ,lCl1h:wJ) ,
. :u>r~e>
APPROVED:
Date
Systems Development Charge Is due on all undeveloped
properties within the City IImlls which are being Improved.
ADDITIONAL COMMENTS
_ "I(11~f) ;IX, MJ)U.-tMf1)'v1i<'1Y'
-t1J Lf\Nir1J1.f! lfr'rrr\ IT.!
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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
01 the State of Oregon pertaining 10 Ihe 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 wltl remain
on the site a'}L7t1mes dDrlng ~O~uctIO:""
Signature U~~ ~~
Datp , F s:- d 1:.- f'"c
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VALIDATION: '...J 0,/,',' r /./ ~
RECEIPT NUMBER " : ,^ ..~ Q
DATE PAID ,~Ioq~\ _ {~
AMOUNT RECf'.l':JD [(fe"'i;~ '\ (Cfq~
RECEIVED B.t-p1JYJ.. / -""::'n ~~",:'13 'I
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SPRINCFIELD
DEVELOPMENT SERVICES DEPARTMENT
225 FIFTH STREET.
SPRINGFIELD, OR 97477
(503) 726.3753
FAX (503) 726-3689
MOBILE HOME AND MANUFACTURED HOME AGREEMENT
UNITS TO BE PLACED IN A PARK
As required by the City of Springfield Development Code and/or the State of
Oregon, I understand and agree, as shown by my signature on this form, that with
the",~va). Slf the a ttac9~d_~IJI!.i ts fora home to be located at '
C\/ () ~L2IJ~~~ ) , Springfield, Oregon, City Job Number
ci }llon I will meet or exceed the below listed minimum setbacks.
Home Setbacks
10 feet from a park building
20 feet from any public street
5 feet from any rear space line or interior space line
5 feet from the edge of a park street
2 feet from the interior edge of a park sidewalk
Accessory Structure Setbacks
10 feet from a park building
20 feet from any public street
5 feet from the edge of a park street
2 feet from the interior edge of a park sidewalk
3 feet from an interior space line or rear space line
I further state, by my signature below, that I have been provided with the
following information,
Manufactured Home Blocking Requirements
Minimum Requirements for Permanent Steps
- Electrical Connection
a~~
5- 21:,- 't tf
Date
Sig"fure
!
CITY OF ~~r(!t;GFl[LD SYSTCi.\S ()[V[LOP:.\[iiT Cid\uc:. QU7V)/ -I"l
. WORKSHEET'. IU {([}.J
(COli/1CRCIAL t. RESIOGlTlAL) ;(taoo
"A'." Oil mWNIY, J:tO"cTJ"-.bQ.,^^ rJI.'.&L ~,- Z ~ p"", .
lOCATIOil: S[)L -io17iS p,.'...\\). \I.JJ-l(/N M,OP..>'t..-E::. \-k:v\S I'::> ~/\O\l:G'::> '\r-\.
DEVELOPMENT TYPE:
[JUIlOING SIZE:
LOT SIZE'
.SQ. Ft.
1. STORl,I ORA Hlr,GE
II.:rERVIOUS SQ. rr. X SO.lSG rER SQ. FT.
(See Re\'e!"~e ro!" nt!:loff Coefficie~ts 'If t,ctti~l kpen. t,!"e~
\s &
I~ Unkno;,n)
Z. SM:lT,W( SE,im-C!TY
1:0. 0:: rru' S I Lj- . X S3S - 55 rc:: reu
(See Re\'er~e To O,~Lel7.1ine Tut~l rfU'S)
I~ C;"?q'~ I
:l. 1:~~'.~L~;~.~.:~T..~.l_~.G':.
r:~ C;: U::!T:; X T~~::' :~:.Tr X (CST PC::'. T:11;)
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(See ^--'c:.-,.,..,.. L' '1'.., !\\;'-,--.;n,. -r-;.... l::;""r~
\....... .....:....... v l..\...~:.:. ......1.: i. ,OJ ...........-J
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SUGTOTAL . (ADO IT :;i-:.s 1, Z. &:; S I '" -
4. AOI-lllH STPJ\T!V[ fEI:S
'IlJ\SE CHl'.RGE (SUSTOTJ\L t,sOVE) X ;05
h ?'SI~ I
IG7....~. -:: ~ ~':'
,--.-
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....-- -.
5. SAtlITMIY SE'riER-H',il'\C
.,....:.. . ....
: ..,', NO. OF PFU'S
. ,..{-
x S13.25 PER PFU .+ S10 'H\.IHC mYoIN. FEE ~ 1"1 C, ~
.~~ .'
..h. '" ',. ..... .' ..:.
._. ..~'. ....~.> . ..... -. '-'..
:y<:: ::.:~:(Use PFU Total F;o~It~~' i Abovei
. ..' '... . _.. ..... _..... ...r_ ._.,:.
..... .-...... "'--'
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TOTAl-H"IMC sac. Is 1'1 S ~ J
TOTAL sac i33 L, e
,:. ~lWHC CREDIT IF APPLICABLE (SEE REVERSE)
.:-':/-:: .:....:..: . . ...... ......:.. - .:. . .
. '. ~.. -- ., '-f /J-'1 /q-y
"':":" '. , .'. G Ki P Burdick.
SOC coordinator
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JObNO.~
SYSTEMS DEVELOPMENT CHARGE
, WORKSHEET
NAMU\o~-Af)ruJ~Q~ .
ADDRESS:~ ~g?{) \ ~mWcill STATE~ZIP q'}tsf
PHONE:
, LOCATION OF IilROPOSED B4'tDI~ ~~E' /) 11 11/1) # r} h/7'\ ,
Street Address if Known: N.-/l'J..) ( LU/lU...-/ CI '^-.U
-- --~--- -- .
~ 5df1fJ~ L~ Nom"'" Jr)/).'J,/lfll/)j''J44[/J
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling type
delinitions are on the back'>
A. Sim!le Familv - Detached
Single Family home
NOOF UNITS
Manufactured home not in a park
X $400 PER UNIT _=
$
.
B. Sinl!le Familv - Attached
NO OF UNITS
X $370 PER UNIT =
-$
C. Multi-Familv Aoartment
NO OF UNITS
X $277 PER UNIT =
$
D. Manufactured Home Park
2. SDC CREDIT (if applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet.
$ cOfb.C:O
$ LiPD{XJ
$ 0'
3. TOTAL WPRD NET SDC ASSESSED (if SDC reduced lor Creditl $~[!J
U (..qk -
M~/~
Date 1) .0 1/
1"/.26-/'1' -,
);?c..pr#. f,""3~~s
NO OF UNITS
I
X $280 PER UNIT =
WPRD SDC
CO~~JMc~O f.)
City of Springfield , ,-