HomeMy WebLinkAboutPermit Building 1993-12-22
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.,F.lESI'DENTJAL
'PERMIT APPLICATION
Inspections: 726,3769
Office: 726.3759
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SPRINGFIELD
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JOB NUMBER
~ "3/?S';:>4/
225 Fifth Street
Springfield, Oregon 97477
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TAX LOT: ~ ~t::>-;::>
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LOCATION OF PROPOSED WORK: 2/5"0
ASSESSORS MAP: /?-o?-.??-/~
OWNER' d~.47iP5 _ ~/~~
ADDRESS' '7/' '7 {'/~.rAiL~/~~
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LOT'
CITY:
DESCRIBE WORK'
NEW
REMODEL
BLOCt<'
STAT~'
~/ -1"_
SUBDIVISION:
PHONF' /t:;l'?-""'3c:>//
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q~~
k/??t:S'
ADDITION
DEMOLISH
OTHER
ZIP'
.::::>/V
A~ _~9'C: e:-
~p~,...
PHONE
~~;;o-~
CONST,
CONTRACTOR'S NAME ADDRESS CONTRACTOR' EXPIRES
GENERAL: $:;. '7Z!>/'1cr ~C~ ./l.:-/-/= "'. .%q~~~-. ~~ "'-<S'-~
1#':-- - , /~~ . r . # , . /
PLUMBING'
MECHANICAL'
ELECTRICA' '
- OFFICE USE -
QUAD AREA: LAND USF' FLOOD PLAIN: A
. OF BLDGS' '. OF,UNITS' ZONING CODE: ~
OCCY GROU.P:' ' , CONSTR, TYP'" . OF BDRMS:
. OF STORIES: HEAT SOURCE: SECONDARY HEAT'
WATER HEATER: RANG'" SQUARE FOOTAGE:
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.
D Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumblng/Eleotrlcal1
MechanIcal - PrIor to cover.
o Footing - After trenches are
excavated.
~ q.;"f1"t::>l'r
o ~...a...s~nry - Steel location, bond
beams, grouting.
o Foundation - After forms are
. erected. but prior to concrete
placeme~t.
o Underground Plumbing - Prior
to filling trench,
o Underlloor Plumbing/Mechanical
-.Prlor to Insulation or decking.
o Post and Beam - Prior to floor
Insulation or decking.
o Floor Insulation - Prior to
decking,
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench. .
o Water Line - Prior to filling.
trench.
o Rough Plumbing:'" Prlo!'to
cover. .' .
REQUIRED INSPEqlONS
o Rough Mechanica) - PrIor to
cover. . .
o Rough Eleotrlcal - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrIcal power.
o FIreplace - Prior to facing
materials and framing Insp,
o Framing - Prior to cover.
o Wail/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping,
o Wood Stove - After Installation.
o Insert - After fireplace approval
and Installation of unit.
o Curbout & Approaoh - After
forms are erected but prior to
placement o(concrete.
o Sidewalk & Driveway - After
. excavation Is complete, forms
and s.ub-base material In place.
o Fence - When completed_.
o Street Trees - When 'all required
trees are planted. '. '
o Final Plumbing - When all
plumbing work Is complete,
o Final Eleotrloal - When all
electrical work Is complete.
o Final Mechanical - When all
mechanical work Is complete.
o Final Building - When all
required Inspections have been
approved and building Is
completed.
o Other
MOBILE HOME INSPECTIONS
1\71 Blooklng and Set,Up - When all
~ blooklng Is complete,
rVl Plumbing Connections - When
~ home has been connected to
water and sewer.
rYl Electrical Connection - When
LAJ blocking, set,up, and plumbing
Inspections have been approved
and the home Is connected to
the service panel.
IVI Final:':" Afte., all required - .
~ Inspections are approved and
porches, skirting, decks. and
venting have been Installed.
. . (tiTHE PROPOSED WORK IN THE '.
..tY- ,
Lot faces Lot Type Setbacks --.
Lot sq, ltg, ~L Interior I P,L. HSE GAR ACC I ....HISTORICAL DISTRICT, OR ON
IN ;lO I THE HISTORICAL REGISTER?
Lot coverage ~9c> Corner /P If yes, this applloatlon must be signed
~~ Is /3 I and approved by the Historical
Topography Panhandle lw. ~ 1,...;., Coordinator prior to permit Issuance.
Total height Cul-de.sac
IE I?N/#. APPROVED:
f- 9::2<3. ~G
6 ~ .$."CJ
... .... ~
''3. ,(::r
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SYSTEMS DEVELOPMENT CHARGE (SDC)
99t:s. "/0
BUILDING PERMIT
ITEM SQ, FT, X $/SQ, FT,
r#~~~.-rs-
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~J::;'I;" /P./C>
Main
Carport
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Total Val ue
Building Permit Fee
State Surcharge
Total Fee
(A)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanitary Sewer FT,
Water
FT.
FT,
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsertl Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
It
Curbcut
Demolition
State Surcharge
j~('-'~"'4' ~A!: .:5~ C.
.
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
VALUE
;J ~ =?ere>
,
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FEE
"'2 < Dr:>
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1,//0. '2 -S-
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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 Springfield, 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'
Date Paid:
Receipt Number"
Received By: -
~~~~ ~?
<PJll'1'~evle'wed'BY( A - ~
1'2 -2?-.., ~
Date
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved,
ADDITIONAL COMMENTS
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By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that alt
Informatlon hereon is true and correct, and I further certify
that any and all work performed shall b~ 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 site at all times during construc~'
Signature V r::7- ~ ./ ~~I
Dat~ ,,/[;-- ').-~ - 1f.3 '
VALIDATION:
RECEIPT NUMBER
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//-::2//
DATE PAin /~- ;l ~ . '9 '3
~"""" ""~.YC::>
AMOUNT RECEIVED i"~..I""
RECEIVED BY ~~-_......
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CITY Ol~ srRlt;GFI[LO SYSTGIS O[V[LOi',,\[i;; l::I,i\uc:
. WOR!(SH~ET'. } ~~
(COI1IiCRC I ^L t, RES I a [liT I ^L) r/'e::ttJVf 7 '3'/$ '? 'Y
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rWl[' Oft COIWAfIY: J:~Lo.0-J".t\_,hQ,0" r-Ag.o L':::.f_ \:-!.O:-^ ~- ' p."d.:t.I;1f~. '
LOC^TIOtl: SD(, -rol?.F- 6:.':!~ltvrJ Mm".:>Il--l2. U-c:v\\S I".::> t--/\O\J~';:>\f...\ ' ~E2~
OEVELOrl'lEllT TYI'[:
(JU I LD mG SIZE:
,LOT S I 2E_
SQ. F t.
1. STORi': DRMil^GE.
HWERVIQUS SQ. FT. - X SO.lSG PER SQ. FT, Is e-
(See Rever~e For R~naff Coefficients 'If ^ct~~l Ic~crv. ^re~ I~ Unknown)
2. S1',r:TT/\rZY SE~iE!~-(rTY
1:0. 0:- rru's I Lj. X S35.55 P[:i P::U
(See Revcr~e To U~tClninc Tat~l PFU'S)
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'See ^t:::'c::~c:1:-Ci':J lh~;_".::!""::~n~~ 1";-:,0 r~~""'~
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SUGTOT1\l'(JiDD IBIS 1,2, &. 3) S '0'-'j...
4. ADIHIHSTPJ\T!VE FFtS
'uf,s;:: CEJ'.RGE (SUBTOTAL ASOVE) X ;05
I::; 7SI~ I
107:..~_-::~~':'
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5. SAtIITARY SEWE,Hf";!-\(
, ,'q,llO. OF PFU'S
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.,:<<;':,'2:(use ~F~ To~~i
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x S13.25 PER PFU .+ S10 1-II-IHC ADXIN. FEE S /4 '? ~,
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~lWHC CREDIT IF APPLIC!\BlE (SEE REVERSE)
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TOTAL-MW~IC SD'~: Is l'1c;~ I
TOTAL, SDC i.93 L, <I:!!-.
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, q,..;." ..qO .Kip Burdick:.
sac Coordinator
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Job No. 93 /~:;:> '7'
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME: t!~G5 ~/~
ADDRESS: 7'7</ /Y ~:R7'~;;UZ;:>~~ ~..R:,PSTATE:~ ZIP "7)>~
PHONE: 70/::>- -'7&::>//
LOCATION OF PROPOSED BUILDING SITE:
Street Address if Known: "'7/5"'0 L.avJI94 ~n , ~-;;u~/.:.
-./ ~ /'
Platt Name:
Tax Lot Number:
1. DEVElOPMENT TYPE (Check appropriate dwell i ng(s), SDC Calculations and dwelling type
definitions are on the back,)
A. ,Sinl!le Familv - Detached
Single Family home
NO OF UNITS
B, Sinl!le Familv . Attached
NO OF UNITS
C Multi-Familv Aoartment
NO OF UNITS
D. Manufactured Home Park
NO OF UNITS /
WPRD SDC
_ Manufactured home not in a park
X $400 PER UNIT =
$
X $370 PER UNIT =
$
X $277 PER UNIT =
$
X $280 PER UNIT =
$ "24'~.-'"
$
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet.
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced for Credit)
~~;S;rViC~~-'7
City of Spri ngfield
$ ./\/.L.
$ .21!>;?, '-0
/2 / '2~ / <9.".
Date
-
.
,
The following proJect all .vb . ad h h ,., ,
zoning, end doe. not ro' , ost 0 ,
225 .FIFTH STREET approyal, ~q ro s .lIe lmEeTRICAL PERMIT, APPLICATION
SPRINGFIELD, OREGON 97477. ., , .
INSPECTION REQUEST: 726-3769 l,."ft,n . . Ci ty Job' Nlimber 93/87Y
OFFICE: . 726-3759 . Onto .' I . .
. .. .:t:k I COMPLETE FEE SCHEDULE BELOV
1. LOCATION pF INSTALLATIO~uthorized Signs~ure '\ /1 \I '
;) 1::)0 L..", IV-G ~ '] 0 b A:' Nev Residentla;:-Single or
" Multi~Family per dwelling unit.
LEGAL DESCRIPTION Service Included:
17.t:J~--z.:7.k:>. ~ ......V~ Items Cost Sum
.
JOB DESCRIPTION I
J-OO A Xr-.JiC -<C. 1'1. ct"
hoi.,",""'e..
Permits are non-transferable and expire
if york is not started within 180 days
'of issuance or if york is suspended for
180 days;
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor R......,......l..w
Address 4JJbSlJe",L.VV',-, G '
City F-rJ I [r . Phone' 'ifl3 71 ~
. ..s
Supervisor License Number '.3 4 fj:J....
EKpiration Date to - <1. ~
Constr Contr. Number .~C 1...U-J..;yf::,L
EKpiration Date '-I, (1-. -
~r~re of YSi,~g
.. !doers Name ~I A./Y.?~ t71/5~
Address
City Phone
OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Owners Signature:
------------------------
DATE:
RECEIPT .:
RECEIVED BY:
/~~9V
00 ~..,
/" /,,.7 . 2
"/
.
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof.
,Each Manuf'd Home or
Modular Dwelling
Service or Feeder ~
B.
Services or Feeders
Installatfon, Alterations
or Relocation:
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
$ 85.00
$ 15.00
$ 40.00 .SQ
$ 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 volts
D.' Branch Circui ts
$ 40.00
$ 55.00
$ 80.00
see "B" above
Nev, Alteration or EKtension Per Panel
One Circuit S 35.00
Each Additional
Circuit or vith Service
or Feeder Permit ~. $ 2.00 ~
not included)
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 .
$ 40.00
$ 40.00
$ 20.00
$ 36.00
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