HomeMy WebLinkAboutPermit Building 1994-7-14
RESIDENTIAL
PERMIT APPLICATION
Inspections: '726.3769
Office: 726.3759
LOT'
.
SPRINGFIELD
.
JOB NUMBER q4/ ~S I..L.
--. , .
225 Fifth Street
Springfield, Oregon 97477
SiPrf?~)V "- F;;=:L/? O/(,
o..//"v\ A rv '\
TAX LOT' L.f\\l J...J
SUBDIVISION:
OWNER: f(iCK f i?AI;~oll/'(}- m~R-r:/V-
ADDREis\t~() ~\~ ~u~Cl.J
CITY: ~YJ\ Ln,(,~ -~ ]I. HJ_ ' STATE:
DESCRIBE WORK' SiTf".. tfRfP- UT:L'jTY<;~ lOhCIPEr.E-
I
NEW 1/ REMODEL ADDITION .' DEMOLISH
1
r5J<ou/IJ/.
57
BLOCK'
PHONF' 79 7 ~ S- 6 S-
OAOL\~AIP~'t1J
OTHER
A-WIV ;1"\--'j5'.
v
"
J)ti't. /'ho'v-riz
CON ST.
CONTRACTOR #
IO()Cjq7
EXPIRES PHONE
1L9ji!5076
o Rough Mechenlcal ...: Prior to
cover. '
o Roug'ti Electrical - Prior to
cover. .
o Electrical Service - Must be
approved to obtain permanent
electrical power.
O Fireplace - Prior to facing
~ materials and framing lnsp.
~ra~lng - ,- r: to c ver.
DWell/Ceiling InsJlallo - Prior to
cover,'
o Drywall - Prior to taping.
o Wood Stovo - After 'nstallatlon.
o Inser1 - After IIreplace epproval
and Installation 01 unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concret.e.
o Sidewalk & Driveway - After
excavation Is completo. forms
and'sub.base material In place.
.0 Fence. - When completed.
o .,Street Trees:"" When all required
trees are plante~.
QUAD AREA: \Q'i\)\ J.. J - OFFICE USE -
LAND USE:' \\ SO FLOOD PLAIN'
. OF BLDGS: \. # OF UNITS: \ ZONING CODE: u)r~
.\<.~ ' '.J1AJ ~
OCCY GROUP: CONSTR. TYPE: . # OF BDRMS'
# OF STORIES' \- HEAT SOURCE: Fer..... SECONDARY HEAT: -
WATER HEATER: q./ RANGF' y./ SQUARE FOOTAGE: 1rlC1 UJ_
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
mad.e the same working day. Inspe9t1ons requested after 7:00 a.m. ~III be made the followIng work day.
REQUIRED INSPECTIONS
o Flnat Plumbing - When all
plumbing w9rk Is complet.e.
o Final Electrical - When all
electrical work Is complete.
o Final Mechanical - When all
mechanical work Is complete.
'-
o Temporary Electric
."
';~:
'"
,
o Masonry - Steel location, bond
.beams. grouting.
o Foundation - After forms are
erected, but- prior to' concrete
praceme~t.
o Underground Plumbing - Prior
to filling trench.
o Underlloor Plumbing/Mechanical
-,Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
o Floor Insutatlon - Prior to
decking.
~anltary Sewer - Prior to filling
~"'rench.
o Storm Sewar - Prior to filling
trench. '
rvrWeler Line - Prior to filling
!7AI trench.
o Rough Plumbing - Prior to
cover. .
~Flnal Building - When all
required Inspections have been
approved and bUilding:=. A-
comPleted~pov \
o Other
MOBILE HOME INSPECTIONS
~IOCklng and ~et.uP - W~en all
~brOCklng Is complete.
fjlumblng Connections - Wh~n
orne has been connected to
water and sewer.
?Etectrlcal Connection - When
blocking, set-up, and plumbing
Inspections have been approved
and the home Is connected to
the service panel.
~r;lnal - Alter all required
nspectlons are approved and
porches, skirting, decks, and
venting have been Installed.
/
Lot faces
L~t~yP.
Lot sq. fig.
Interior
Lot coverage
Corner
Topography
Total height
Panhandle
Cul-de-sac
BUILDING PERMIT
ITEM
sa. FT.
X $/SO. FT. = VAWE
Main
Garage
Carport
Total Value
Building Permit Fee
\ .\lO +-
State Surcharge
Total Fee
(A)
; \ ';' " "'''':'\,'1:' :t..j ~;.:.~~ '~':~~~.,:~,\fi
Setbacks.
'.h~L.
IN.'
Is
Iw
IE
'IS THE.PROPOSED vVORK,tN 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.
HSE GAR ACe' I
I
I
I
I
'.
A f) [)o.uP
,
~4n5)
\.C\~
4\.~
SYSTEMS DEVELOPMENT CHAR~~DC~........
. (B) ~l
PLUMBING PERMIT
ITEM
lfb.oJ
\ qs-\- ~Q5
f)O.60
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT,
FT.
FT.
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State issuance
State Surcharge
~
~Iti.<>...<lo.;:.
Curbcut
It
Demolition
State Surcharge
FEE
~~
\S CO
11
1f)5.CP
c:;;)(j ~
.,5. AS
0.\~
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrICal)~S,\q
(A, B, C, 0, and E Combined) Uf-\\O~
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 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:. /
Plans .Revlewed By
Date
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
.>o/..-v'.(J7A'J.A ~ "{"/b../~
A-l"l:frml) /2'X~2:'
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By signature, I stale 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 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; ~hat 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 I times rLti:~s~uc~on.__
7 "1\j-9~~
-,
Date
VALIDATION:
\~:HcY\
:,15 (G\C\ I ()1{))
j
RECEIPT NUM
!
~4\~
IWl[ 0[( CO!.lIWIY: J0_q~~J:,._.hQ.0t. rJ\9.& L'=.f:- ~o:J\!::.' p.,~ #.10( ()
,
lOCATIO!l: SDC. --ro7.F- \2~~ltv!J ~->IL..-12- i-k:v\S t':? !-1'O\l~~\;-\.
CITY
OF ~Rli:GFl[LO SYSTU1S_ OEVELOI',I[i,;
. WORKSHEET'.
(CO/lI1CRCIAL t. RESIO[IlTIAL)
c: ::"Ii, en:.
O[VElOPl-\[llT TYPE:
OUILOI1iG SIZ[:
LOT SIZE
SQ. F t.
J. STORl-l ORAI11^GE
IHPERVIOUS SQ. FT. X SO .18G PER SQ. rr.
(See Rever:e For R~noff Coefficients ~f Act~3l Ic~erv. Are3
\S &
I: UnknO'o,n)
2. s^r:rT^RY SEWEll-CITY
1:0. 0:: pru's I Lj. . X S38.55 I'D p::U
(See Rever:e To U.:temine Tot31 pru'S)
Is '7?<j'~1
.'. Ic!:~r~_~J_~.:rr..:..I_~.G:.
r:r; c:- t:::!T:; X 1:~::' !.~...T;: X (CST P[::. Trti~')
I
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(See ^t:~C:;:::~;1: L i'o lkt'2;::iJ;Q Tr~p R.:':~:)
- - (IT -) -- ( ~ -: ~
SUGIOIAl' ADO ,I1S 1,2, ~ ~ ~ I" ~
4. AOI-ITIHSTRATIVE FEleS.
.Of,SE CHl',RGE (SUBTOTAL 1'.50\'E) X ;05
\s "7'OI::!.- I
1(;7....:. -( ~ ~':' ::~;::
C>"
... c.-r .-
,-,-- -
s. SMIITMIY SE\-IE~-M'rll'\C
- ",,:..
.110. OF PFU'S
, ,..f-
x S13.25 PER PFU .+ S!'J 1-\WHC AD:'.IN. FEE: S /4 C; ~.
.-~ .'- ":.
.....
.........
. .', ..........: ...... ," . :".-' -'.'-"~' .-. "' --....- ~..... .
. , '.::.:':.",:.:~'(Use PFU Total From 1te~' 2 Above)
.. '., ' '. '~1~;1~ C.R~DlT~ IF - ^PpCi~~lE (S~~ REVERSE) ..
. :'"./.:: .>0::. ..: ~:. .... ":' ,.,
~,.. ........--'
... .. . "..
"
. ..,,~~,; ;,' ..(fKip Burdick
sac Coordinator
...
- '--", - .'-. :......
. .. .~. ,-
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<t /~'1 /'f'V
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TOTAL-MIme ~oc [S 14":J~ I
TOTAL SOC ~ ~ '/:!!...
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SPRINGFIELD
DEVELOPMENT SERVICES DEPARTMENT
225 FIFTH STREET
SPRINGFIELD, OR 97477
(503) 726-3753
FAX (503) 726-3689
'MOBILE HOME AND MA.~UFACTURED HOME AGREEMENT
illlITS TO BE PLACED IN A PARK
As required by the Ci ty of Springfieid Development Code and/or the State of
Oregon, I unde~stand and agree, as shown by my signature on this form, that with
th^jl.QPFJ{V~'the attas;hEid p'ermits for a home to be located at
a.l'~ ) llJif)./#- f()7..p , Springfield, Oregon, Ci ty Job Number
~~i~ , . I will meet or exceed the below listed minimum setbacks.
Home Se t backs '
10 feet from a park building
20 feet from any public stroet
5 feet from any r~ar space line or in terior 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 str~et
5 feet from the edge of a park street
2 feet from the interior edge of a park sidewalk
3 feet fr.om 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
7 '/'I-~Y
bate
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