HomeMy WebLinkAboutPermit Building 1994-7-7
"
RESIDENTIAL
PERMIT APPLICATION
Inspections: '728.3769
Office: 726-3759
.
LCCA~ICN CF PRCPC\*RY'CRK: ('? /"5" c
ASSESSCRS MAP' . II ffi'1l) ,
(7!~J7?/ck r /~A-L.St/!/.
72<;5' t!?c. c. s '-""~?fr.6/
,~15'~~ ",
,
DESCRIBE WCRK: ? 4f.Cb/?7~~~~ .;f!-7L?;~ ~~/ ~~/') ,/" ~A'??'c;; ~
NEW ~ REMCDEL ' ADDITICN "". DEMCLlSH CTHER I.. , .
LCT'
CWNER:
ADDRESS:
CITY'
('.I(t..~,..f..4
-. . .
BLCCK' .
STATF'
8?? .
.
JCB NUMBER
CJo/t98S' c:s
225 Fifth Street
Springfield, Cregon 97477
$?'k-~ <::?~
--T:~LDT:~) ,
SUBDIVISION: /7:?AJ.A7 /4 ~~A
,/ , (~ -Yo
PHCNF'
92r:=~ /C',/V9
,ZIP'
?7? "3'<. /"
CCNST.
CCNTRACTOR'S NAME AD~.,. .....-Le. ~ CCNTRACTCR # EXPIRES PHCNE
,/7 /7'_ _c...c;>' J ~-A~::>~ ...'
GENERAI./..-;;>A5l!5Zf~~j" ~r-&1 .q?~ .r;>~..,r.~~ ...",r:>
'" L-r ./ ,.
PLUMBING' . ~,'.' .-
MECHANICAl' ' M .
~ .~ '~:l~
ELECTRicAL' c.A-.-'u=-", ~~J"'CiI!:>.
QUAD AREA: \~\\,h )
# CF BLDGS: \
CCCY GRCUP'\V.~ I'
# CF STCRIES: \
WATER HEATER: P ./
- CFFICE USE -
LAND USE: \ \ t;=:{)
00
CCNSTR. TYPE:--r=E':
HEAT SCURCE: 'L..--
U
# CF UNITS:
RAN~C.
FLCCD PLAIN:
ZCNING CCDE:-1f'A2..
# CF BDRMS: J).
" -,
SECCNDARY HEAT: t:J"
SQUARE. FO,CTAGE:
To request an In.pectlon, you must call 726.3769. This Is a'24 hour recording. Allln.pectlons requested before 7:00 a.m. will be
made the same working daY,ln.pectlons req.ue.ted alter 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
D R~U9h Mech~nl~al ....: Prior to
cover. . . .
D Temporary Electrl.c
D Site In.pectlon - To be made
after excavation, but prior to
setting forms.
D Underslab Plumblng/Electrlcall
echanlcal - Prior to cover.
Masonry - Steelloca lon, bond
,beams. grouting.
D Foundation - After forms are
erected-but- prior to'concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D Underfloor Plumbing/Mechanical
-.Prlor to Insulation or decking.
D Post snd Beam - Prior to floor
Insulation or decking.
.. .
, "-
D Floor Insulation - Pilor to
decking.
~ssnltsry Sewer - Prior to filling
, trench.
Storm Sewer - Prior to filling
trench. '
.rz:;rwater L1n<, - Prior to 11II1~g
r trench.
I , .. Q. Rough Plumbing - Prior to
l ~\' ~ cover. <.~ \ .
l:
D Rou~hEle~tricsl, - Prior to
. cover. .. , .
D Electrfcal Service - Mu.t be
approved to obtaIn p~rmanent
electrical power, 7. ""':1'
D Fireplace - Prior to facing
materials and fra'1'lng In.p.
~ - Prior to cover.
D Wail/Ceiling Insulallon - Prior to
cove~ .
D Drywall - Prl.or to ~aPlng.
D Wood Stove - After l~stallatlon.
D Insert - After fireplace approval.
and Installation 01 unit. .'
D ,Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sidewalk & Driveway - After
excavation Is completo, forms
and'sub.bas"materlalln place.
D Fen~e. - When completed.
o Street Trees - When all required
. trees are planted.
D Final Plumbing - When all
plumbing W9rk Is complet,e.
D Final, Electrical - When all
electrIcal work Is cOf!1plete.
D Final Mechanical - When all
meChanl?sl work Is complete.
nal Building - When all
required Inspections hr;;:rve bee
epprovedan?-t~I~ln .
completed. \.)}.Iv
D'Clher
MOBILE HOME INSPECTIONS
~IOcklng and Set.Up - w~en all
T ~IOCklng I. complete. '
~IUmblng Connections - Whe~
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.
~al - Alter all required
. nspecllon. are approved and
porches. skIrting, decks, and
venting have been Installed.
Lot faces
L~/~pe.
Interior
'\
'.' : "',1':," :i::" 'j ~ :....,1. ~...i:a." ,l:'
..~'
THE PROPOSED WORK IN THE. '
, ISTOI:lICAL DISTRICT, OR ON
THE HISlORICAL REGISTER?
If yes, thla application must be signed
and approved by the Historical
, Coordinator prior to permit Issuance.
Lot sq.' fig:
IP.L.
IN
Is.
Iw
k
Setbacks .
'H~E'GAR'ACcl
I
1
I
Lot coverage
Corner
Topography
Total height
panhandle
Cul.de,sac
BVILDING PERMIT
ITEM sa. FT. x $/SO, FT. = VALUE
Main ~~ ~~
~ ---.. I
/..70 /q'./O '. /69-<.-
Carport ~ /~,/o :2 .y2."J( -
Total Val ue
4\ \\1>
~ t:'{J.5D
\.~Z:+ c-j.~~
(A) .~.~
Building Permit Fee
Stale Surcharge
,
Tolal Fee
SYSTEMS DEVELOPMENT CHARGE ~DC)
(B) !1Y{ 0:90
-,'....
~
.
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s) N'
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
Mobile Home
r9s.co
6JS.()C)
IS.CO
Plumbing Permit
State Surcharge
Total Charge
loSpu
!q~ \.3.a~
'K).@.()
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnserl/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
t?!
\OS~
dl( )~
\.c::;. & r:;.
~..LS
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
~
C:,Lu_::.
Curbcut
fl
Demolition
Slate Surcharge
Tolal Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrlcal;{~ .~::'\
(A, B, Co 0, and E Combined) (t{y,\()"\t> J
.
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:
_ ~""'7'
)/;S.;. ?>~
C". ~ ~C{
/'
Date Paid:
Receipt Number:
Received By:
Plans ,Reviewed By
Date
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
By signature, I state and agree, that I have carefully examined
the completed appllcallon 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
I '
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 tlme,that each address Is readable
from the atreet, that the pem;lt card Is located at the front
of the property. the a proved set Of~la s will remain
on the sl s _ Ing co~1 /f /
SI ~Pu-LUl~~/
Date' V
l
VALIDATION: ~p.c. / ~ 7'7 t'
RECEIPT NUMBER e1T~ /'3~2.
DATE PAID ?-. 7~~ 9" , ~
~~~r'J~8.\~, (g:\l~~)1
RECEIVED BY ~ l.o2.4.ros) ("f-~....
!
CITY OF ~rW;GFI[LO SYS,TG1S_ OEV[LOPi.\[i,T C:::,i,i..a:.
. \VOR1\SHEET"
. (COI1l1CRCIAL t, I\ESIO[1lTlAL) . -
HN:E.O[t COi.lIWIY: J:J.o.~J"J:,__.bQ_0f>, r-^.9_& L~f_ \40 WI t::. . p"U
LOCATlO!I: SI)(, -to '17c. p~~\l).\"J;':(/!J 0I,OP..>I\'-'12. \-k:vIS t':::> !-/\o\ll2-c:> '\f.-I.
DEVELOPMENT TYPE:
[JUILDING SIZE:
,LOT SIZE.
.SQ. Ft.
1. STOm.! ORA I WIGE
WPERVIOUS SQ. FT. ' X SO.lSG PER SQ. FT.
(See Rever~e For R~noff Coefficients If ^ct~~l I~perv. ^re~
Is &
I~ Unkno'"n)
2. SMI lTM(,( S;:,iF!Z-C lTY
r:o. OF rFV'S I~' ,X 538.55 rc~ rFV
(See Rcver~e To O~tel~ine Tat~l rFU'S)
\:; ?"?9"~ I
~,. 1;~!~'~L~:J.~.:~T::'I_~.G.;:.
r:~ C:- I~::!T:; X T::::' :~:,TI~ X (CST P[::. Till[)
l-.;~:
--'-"- ---
~: j3::::.C~
\ ...,...... :J'.. I
.~ 1..;";'-'
. '!. ~::;::.. G ~
.~ ____ :( ~::::.G~
(See ^t.:::'c::~C:i: L i'o u~t(;;::::r.~ Tr'~p R2.~2::)
, SUGTOTAL '(ADD IEi,tS I,Z. & 3) S IG:..~'::"
4. AOI'IlIH5TRATlVF meS.
'[J,'\SE CHARGE' (SUSTOTAL t,sO\'E) X ;05
k '1;>'31::' I
18-:-:..:.-(17':'
':-~:.-
Q"
~ C. .-r ,'"
.......-- -.
5. SAtlTTARY SE'.Jm-M''';I'!C.
x 513.25 PER PfU .+ 51':) 'H\.:HC A!)XIN. FEE) l"l C; ~
_ "H ,110. Of PfU'S. ,..f-
."~ . -':. ""
.... ."
L....... .
~~. '... '.
. .' .,' . ....-. -. '-"..
:Y:;~:;:'.:~:(Use PFU Total From 1t~; 2 Ab~ve)
- . '... . _.~ .';.'. .... . . .... '.:'-- ---..'- :. .... ",
'-".- -.. - ~
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'H
- '--', ."- .'-.
..' '~.. ". :., : .,
. -, .....
...~n__,.
..;:;:.,'. ,. ,(1 ,Kip [lurdick.
SOC coordinator
.'? ':-'"
TOTAL-MIme SO~ Is 1"7 '? ~ 1
TOTAL SOC ~ G, e
.... ..... .
.... -
........."
~:....-::.-:-._,. ...
. ..-....
'" .' '" ....:..-.......
. /lcr>T ~/~;~I'
7":?;:!"I
~~.?
.:....:':.............
. .;.::::.::.: :.~,:' ':.":'; ~..
":'~':" !.:::: .:"
. ;..:."
,.......;.;
....;'.
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@ Y..':tiR'.!!!!~!~!!~
JObNO.~
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAMEJ~ (AAUAv PHONE: qg~
ADDRf5S22B f~~AT8~ZIP~
LOCATION OF Ii'ROPOSED SUI ING SITf{j =I! "n":l..
Street Address if Known: rlfJ.J.J.11{) .I 0l'N. .
I
Platt Na~.
Tax Lot Number:
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the back.!
A. Sinl!le Familv - Detached
Single Family home
Manufactured home not in a park
NO OF UNITS
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
NO OF UNITS
(
X $280 PER UNIT =
$ o'fl).CO
df(J,CD
$ 0'.
~
WPRD SDC
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See sac Credit Worksheet.
ESSED (If SDC reduced for Credit)
o~ I~~
.
, '..
".'.,..'. ..
SPRINGFIELD
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 shovn by my signature on this form, that vi th
~h ov~the attached permits for a home. to be located at
. ~-W-~.~ ' Springfield, Oregon, City Job Number
) .. 1 vIll meet-or exce:o the belov listed minimum setbacks.
Home Setbacks
10 feet from a park build ing
20 feet from ,an~ 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 sidevalk
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 sidevalk
3 feet from an interior space line or rear space line
I further state, by my signature belov, that I have been provided vith the
folloving information:
Manufactured Home Blocking Requirements
/ (~~~"'P'
~'"<. J
- Electrical Connection
7- 7- ;l~
Date
.
fi lL'!i!I~I!!E!!~!!~
.
Job No.
q1\fB=)
SYSTEMS DEVELOPMENT CHARGE
NAM~~D\ Qrili\rro:~H~
ADDRESS: ~O &\':D ~fL ~
LOCATION OF Ii'ROPOSED BUIWI~,Q)i~ . ~ 111'1 (\ 1\ ~ I D,' '"
Street Address if Known: ~\ 'ct ), 'rt.. J IA L W
ax Lot Number: ~ no~ rMrO
PHONE: f'\4f).~
STATE:OC ZIP d.l1lJ
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dweliing type
definitions are on the back,)
A. Sinl~le Familv - Detached
Single Family home
NO OF UNITS
B. Single Familv - Attached
NO OF UNITS
C. Multi-Familv Aoartment
NO OF UNITS
D. Manufactured Home Park
NO OF UNITS l
WPRD SDC
Manufactured home not in a park
X $400 PER UNIT _=
$
.
. X $370 PER UNIT =
'$
X $277 PER UNIT =
$
X $280 PER UNIT =
$<;:Q rom
$!), P{).(J)
$ (1"
~C60.()()
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)
~o~L~~
City of Springfield
~ 14 1CM-
Date
!
CITY 017 srRU;Cfl[LD SYSTGtS DEV[LOI':,\Ei;i L::""e:c:
. . WOR!(SH~ET' e. Q4'w\O
(COI111CRCI^L t. RESIDENTI^L) /-. 1.6tJ LClUvt1, \
IWI[ art COi'lIW1Y: J:)_o.~J"/:,,_.lQ.0" f\Ag_& L~f'_ ~o ~ E:. . p,,\-~ tJ:-r::!)[) 7
LOC^TIOll: SD(, -ro '17lS (',.'...\\) \r.1i-lVN ,v\,OP.>Ii-12. \-.k:v\S I'? ~/\o\J;2..!:>\~.
(,
O[VELOPI'![lIT TYP[:
[lUILOWG SIZ[:
.LOT SIZE'
.SQ. Ft.
1. STom.! ORA Itl^GF,
Il-!f'ERVIOUS SQ. n. x $0.185 PER SQ. FT.
(See Rever~e for Ru~off Coefficients If Acttial I~~erv. Area
Is &
I~ Unkno',;n)
2. SM:IT,~rcY S::',ir!~-CfTY
r:o. 0:- rru's I Lj, , X $3S.55 P[~ Pet!
(See Rcver~e To U,~tet71ir.e Total prU'S)
I, ??"1"~1
,'. IS!:'~L~;j.~.:~j:~,i_~.G:.
r:'J c;: I~::!T~ X T:~:~' :~.':\T;: X (CST PC? TRU)
\
.-----.-
~.... -: l-~
--.- .'-- -<-
~. r: "';'........ r ~
._ _ -,OJ'.J. '-.
I. ~ ~. :>'. I
t~_t..,:..';' -I
.:
v r-,..,.... ~.
:. .J :..:~:~ . '~ ~
.~ ____ :~ ;:::3.G:
(See A"'c;'-~"''' L' 'I"~ l\~~'-..--;n"\ -I.....:... ~I ......,\...'
\"..._ ............ i.J L;:-:"'';. ,..II,'..: 4 ':-' ..~...,--j .
SUGTOTAL '(ADO IEi'IS I,Z. & 3) $ ,("'-:..~;..
4. AOIHlllSTRAT!VE Fr.E5-
'(l,~SE. CHARGE (SUSTOTAL ASaVE) X ~05
h ?'Ol~ i
107 "'~_-( ~ -;':'
"'...
... C,-r ,-
.....-- .-
5. SAtln^RY SEWER-Ifril-\C
.110. OF PFU'$
. ,.f-
x 513.25 PER PFU .+ Sl~ l1\o:HC ~~IN. FEE S /4 ~ ~
.' '.' .
.. ....- -- ,'-.
. " .... .
...... -'
..; '::'" . ~
, ~ /~1 /1').--
"s '.-'"
TOTAL-MIme SO~ Is I~S~ j
TOTAL socs qq L, i!!..,
, ..:1- ", ..--~:
"'~
..(jKlp Burdick
SOC Coordinator
.. .' ~;;.;...: :.. :. .
..
-:-'-'~.-:_.' -....
. "-a.:"", ,'..
.. ...~ .._..... 0'
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.t.,' .:.,'..;,:,:.:,.,... ; .... ,", ':-
. ':':', \':-'-: ,".'
...... '. .
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.
.
fi !!!ill'!'I!!~!~.!!!;
)obNo.
Cl~D~
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME:~t ~\\'t\'i{\)~HONE:_ .9A~.l~
ADDRESS: - s'n-- STATE:f.f..ZIP!l!l1o.L
'U
LOCATION OF "'ROPOSED BUIWI~~!TU -U /Ilk:!..
Street Address if Known: 01.mtJ( /)f.J.J1J1.1l- -tt'rii'Y..- J
PlattN~ .~LotNUmber. . ,
1. DEVELOPMENT TYPJ; (Check appropriate dwelling(sl. SDC Calculations and dwelling type
definitions are on the back'>
A. Sim.le Familv - Detached
Single Family home
NO OF UNITS
B. Sinl!le Familv - Attacheq
NO OF UNITS
C. [v\ulti-Familv Aoartment
NOOF UNITS
D. Manufactured Home Park
NO OF UNITS (
WPRD SDC
Manufactured home not in a park
X $400 PER UNIT ;r"
$
X $370 PER UNIT =
. $
X $277 PER UNIT =
$
X $280 PER UNIT =
$ ~etJ ,cO
$ r1fj),Cf:)
$ Vf .
$)fXJ
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 lor Credit)
b ~~€)
Community-Services Divl!li~in -
City of Springfield ~ \
lo I P1-1~
Date