HomeMy WebLinkAboutPermit Building 1999-6-14
.
RESIDENTIAL
PERMIT APPLICATION
Insp,~ctioll:.: 1:~G.376Q
OffiCi::: 72G<\!~)9
.
SPRINGf'IELO
"
LOC'~TION (:1' PIlOPO,"ED WOfl": ~,mD-_l"'U~P.I
ASSESSOfl~, r,lAp: _ _ \ '-b3~- -
LOT: ___ .
ST,
SP
13 LOCI<:
OWNER __ _R~_' __eBn/Q&- e..AtL.F-y
ADDf1ESS:, ICo..a~_f}k~T L~,
CITY: _fJJ6f!l.e..- --
DESCIlIBE WORK: _m~l:\oll!t:
NEW__
REMODEL _ _
ADDITION
STArE: _O_~ .
.
JOI3 NUMBER _q](CJ_ 286
225 Fifth Street
Splinglield, Oregon 97477
. 2.2.S-
. -y-\L\TID-- - - -
TAX LOT:t&PrV'\XQ ~-
SUBDIVISION: _U\llU WH ~
PHONE: 'J:1s ~ 667 f:?___
ZIP: 371.p I
--.*,-
--
. .
IN
fA1t.1L
w j.J1:j_A~N'.llb
DEMOliSH
OTHER
CONST,
CONTRACTOR N
CONTRACIOlrs NAME ADDRE~;S
GENERAL GOO.!>f,/J . H1\F;.~ISQ.~ _(~.1/~Y. .j, IJ.
t( cl " ~,
PLUfv113INC: - -.- --- - -
EXPIRES
PHONE
__~c,4<17 __5-7-9S-,___08"-176'l
_ 2.O-Z'36f'B__1I-3tJ -'11..._
t.
ir
MECHANI<~.'\I.: ,___
ELECrnIC"'_ _1::l~J~ _~c...___
QUAD AREA j~ __
H OF BLOCS __ ~ _.__
~CC_Y GROI",' ~~T~J\ -
01- SlOHIE". .__
WATEn HEAr foR: _ y ./
, - OFFIC~-
LAND USE: -1l-~ )
H OF UNIT~,:, _\-.1
CONSTR. 1 YPE: _V..I\J
HEAT SOUHCE: -~.Y
RANGE: -V,
t;, 8 8 -J.~oo
~LOOD PLAIN: -ti'\O' - .
ZONING CODE:...wx.--::.
,6),
" OF BDRMS:
SECONDARY HEAT: --,tt'\71 fA --
SQUARE FOOTAGE: _\,<:::f\Y-.HJI _
To request rUl inspection, you lIlust call 72G.3769. TI1IG Is a 24 llOur recording. All Inspections rcqllcstccl before 7:00 ,1.1fl. will /)0
Illlldc the ~~illllc wOIli.i,IU (lay, in~~pocljons IQqllested after 7:UO a.fIl. will be made the following work day.
Cl Tcmpolilry Elcclri.::
o Site 11l~pCClioll - To be made
al\(:1 'l.-.;avtltion, !.ul pd..ll to
selllllO IOt'llIS. .
,
~ Un<!tHsl..b Plumhill /Efuctrical/'.~'
~ Mechanical - I'do 1+
[]
FOOlill'.l - Aflo;l Ilenches alC
CXC3V:JI,'c1.
CI
Masomy - Stcld locatioll, boml
I)CnllIS, 'Irouting.
CI
FoullClOIlion - Allf~f fonlls are
ereclcll Oul pllOI 10 conG/l)tc
plaCI~III"~nl.
o
Undcl{JIOllnd Plwllbing - Prior
10 lillino trencll.
D
Underllnor Plumbing/Mechanic;;11
_ Pliol to insulation or dcckinO.
o
Post :lIld Serlm - PriOl 10 floor
insulallnn or occldng.
o
Floor Insulation -- Priol to
dcckintl.
~
o
SanitillY Sewcl' - PriOI' 10 fillinU
trend..
Stonn Sewer - PI'ier 10 lilling
trendl.
~
o
Watur Uno - PII", 10 fillillg
trench.
ROUflh Pllll11binO - Prior to
COVE-I".
REQUIRED INSPECTIONS
I~ Rough Mechanical - Prior to
- cover.
~01l9h ~1r:I~C~ior to
" CcWC', 'VV-I \". v
I.:=J Electrical Service - Must be
approved 10 ohtain permanent
electrical powl~r.
[J
Fireplace - Pdo/' to lacing
ITllllerlars :1I1d (lilllllnu Insp,
I~
Frilmino - Pdl), to cover.
I~ W<tIl/CciliIlU IIl~il:latioll - Plior to
cover.
l~
Drywall - Prior to taping.
I~ Wood Stove - Aller In~lallation.
[J Insert - After (jrcplacc approval
and lnstarl:llioll of unit.
o
CUI'bcut & .'\pproach - After
forms arc eruc!C(1 but prior to
placement of concrete.
I~
Sidewalk & Driveway - Afte,
excavation is complete, forllls
unci sub.IJ:lSC lIIatcrlul in place.
l~
FCllce - WIICII cOlTlptult:d.
I~
Street Trees - Wilen all required
trees are IJI~Hltcd.
o Final Plumbing - Wilen alt
plulllbing wurt, is COlllpldC.
rtJ1) Finnl Electrical - When all
~ electri I woll, is c Ilplele.
o Final Mechani I - WIlI)n :lll
mechanical worl< is I:Olllplct,;.
~Final Buildinu - Wilen :III
required insp0ctions lIavt~ 1J'~I:1l
approved an buildino i~.
completed.
DO'hcr
MOBILE HOME INSPECTIONS
~1lI0Cking and Set-Up - WIWll :ltj
LP blocking is c(lmplcle.
~ Plumbing Connections - Wl1un
~ tWine tlaS bcen conrlf:cl,~c1 to
water and sewer.
r\t1 Electrical Connection - Wh(~n
~ blocking, sel-up, and plulIlt>illtl
inspections /lave bCl~1l appnWiitl
and the home is cOrH\l:(;led 1(,
1I1C service pnnel.
f1 Final - Artel' all rcquilcd
inspections are appr\)Vt~d and
porches, sldrting, (jccl~s, and
venting Iwvc bcen in~;udtc:(l.
I ti).ffi
+ .~'L ~.S?>
:-A .S5
Lot faces
.
Lo' Type
Lot sq, ftg,
Interior
Lot coverage
Corner
Topography
Panhandle
Total height
Cui-dc-sac
BUILDING PERMIT
ITEM SO. FT, X $/SO, FT,
Main
Garnge
L\aD
\(').\ [)
Carporl
Total Value
Building Permit Fcc
Slale Surcharge
TOI<11 Fcc
(A)
Setbacks
~ HSE GAR ACC
N
Is
Iw
IE
VALUE
_~!}A~
SYSTEMS DEVELOPMENT CHARG~.lSD~
(S) ~~(~()
to5~
\ q5+__.:i.~
'JD~ao
PLUMBING PERMIT
ITEM
Fixtures
Residential 8ath(s)
N'
Sanitary Sewer
FT,
Water
FT,
Storm Sewer
FT.
Mobile Home
Plulllbing Permit
Stille SUf{;!lilfUC
Tulal Chmnc
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Mcctlanical Permit
Issuance
Slale Surctlargc
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Horne
Stale Issuance
Slate Surcharge
...3%
--
Curbcut
II
Demoli lion
St<llc Surcharge
FEE
As9b
A'S po
\~.co
.PJ
\()~~
A(),
5a5
,~.t5
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical) ~.~
(A, S, C, D, and E Combined)
,it
/ ' ,
81s THE P~OPOSED WORK iN THE
HISTORICAL DISTRICT, on ON
THE HISTORICAL REGISTEm
If yes, this application mll:;1 be signed
and approved by the Historical
Coordinator prior to permil issuance.
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is gr<J.nted on the express condition lhilt the said
construction shall, in all respecls, conlorm 10 the Oldinancc
adopted by the City of Sprinofield, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked al any time
upon violation of any provisions of said orclinanees.
Plan Check Fee:
Date
Date Paid:
Receipt Numbet~:'_.
1i:IDYA
Plans Reviewed By
Systems Development Charge' is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
By signature, I stale and agree. Ihat I have camfully eXi'JlTlined
the completed application and do hereby certify that all
information hereon is true and correct, and I furl her certify
that any and all work performed shall be done in 3ccmclancc
with the Ordinances of the City of Springrield. ;1I1d the Li1wS
of the State of Oregon pertaining to the WOI It; described
herein, and that NO OCCUPANCY will be Ilwdc of any
structure without permission of the Building Safety Division.
I further certify lhal 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 eacll addrer.$ is readable
from the street, thai the permit card is localed ill the front
of the properly, and ttle approved set of plan:; will remain
on the sile at all times during con:;lruction.
~ignalurc/lJ I/~
~-(1-?<?
Dale
VALIDATION:
HECEIPT NUMBEH
DATE PAID
AMOUNT RfE.C1!:1
RECEIVED sQ
"
,
\
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fl. l
.. ~t'"JJA Willamalane
'(;Q' Park & Recreation District
.
Job No. Q4COU
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAMC\\ffirv\Q" ') ~Cfu ; PHONE: 040 4[)\~
ADDRESS:2f\l'2Il t\ ~f\t'~~\ STATE:(;:R .Zlpq1\~~-=)
~
LOCATION OF IilROPOSED BUIL9ING SITE: L. # -#
Street Address if Known: a) lCi) ~ (j LuLl j ~()fJ-J
/
Platt Name:
TaK Lot Number: / /}^'~{J.')I()()14(Y:J
1. DEVELOPMENT TYPE (Check appropriate dwelling(s), 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 - 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 =
$
$ !1PD r.-o
$~ro.cO
$ 0 ci)
~9D.
4: / 2.~ICf\
Date
X $280 PER UNIT =
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)
~ff\
Community Services Divt n
City of Springfield
oi)
1\ ~ CIT1:aol~..rrnrtU[[\?:6~~(T~~~~~r[LO.l'i\[i;i l::.\I\UL. A.7\C:/IO\
" 2}\~:J LJJ~ UJ.-T (CO'''''CI^,' RESIOEI1TIAL) - C\ ~
rWIE(jt COi'iI'AllY: J:~Lo.t::lTt\__lQ_0." N\.9_o l'=.f"- ~o/'J\ E:. ' P.".u
LOCATIOil:, <::JDe. -to '\:7C'. P~~I\)' ,^f~(/tJ !0I,CiP..>Il--P- i-k:vIS I"::> N'\O\l(G':)\f-\ '
DEVELOPMEllT TYPE:
IlUILDWG SIZE:
LOT SIZE
.SQ. Ft.
1. STORr'! DRAInAGE,
U!PERVIOUS SQ. n. x SO.ISG PER SQ. FT.
(See Rever:e For Runoff Coefficients .If Ac~tial I~perv. Area
\S &
I: Un~:nQ',;n)
2. SA1:ITARY SEYER-CITY
r:o. 0:: rEV'S I Lj, . X S3S,55 r[:( P;.V
(See Rever:e To O.~telT1ir:e Total rEU'S)
is ?"?::"\ I~ I
.>. 1;::..,:.~~~:~.'.:~T::'l_!.Q;:.
r:r; c;. C::!T:; X T::~;' :~:.T;: ~ (CST P[::. TrliI)
I
--------
l'" . """": I-~
---- ._- ---
?: ~::::.C:
I: "..... - ::;'.- I
v !~..:..~;._~
v r...,........ r"
. .", ~.:.:~:~.'J~
.,
:~ ~:::3.G:
----
(See ^t::;,c:::::C:1: L i"o O:2t~r::~n~ Tr~p RJ.~~=)
I -(/'-'~
SUBTOTAL '(ADD B:S 1,2, & 3) S I J" -
4. ADIHlHSml\T!VE FEES
'l3,\S;::, CEJU~GE (SUSTOTAL f-seVE) X ;05
h 'Z.7'3I~ I
107....~. - ~ ~ "T':'
,--. -
r C. ,--r 90
'-'-"- -
5. SMIITMIY SEWER-M'riIK
FEE S /4 C, ~
__; ..,.,IlO. OF PFU'S' ,...f- x S13.25 PER PFU + S!() 1-I\.IHC ADXIN.
,:...~:'~.-'..::7"".' ...._. '::,.'~'~_ .-:.:. _..h.......:..::.... .'
':';;',',,:,~:{Use PFU Total From Ite"!2A.bo~e)
. . ".- . -- :.'. '.- . .-:.:- ..._,.' ',- ',-'.'- --,,' ," ;.' ~'.. .
..~ ........ . . .'
..~.o . .
,...... '.
- . ~. ,
..,
" - '--', - .'-. :'-'.'.
....
. :~. -' :: .:-..:
~lW:1C CREDIT, IF APPLICi\BLE (SEE REVERSE)
.0:':'" . ~
. .
- <t /~i /1 'V
I
. ." ,. S
TOTAl-MI.JMe SoC Is 1'1C;~ 1
TOTAL SoCS qq L, <C!:-.
~,...
. ";;;"',',.". ".(j' . Kip Burdick
SDC Coordinator
-" .
...--.....:
..
~::'..-;:.~:_,.
'-.-
.. ...~ --..... ,"
......~,.'..
L\,~'-ff\~\1
. . ....,., .....
..' ..' .... .
. .._.. r."
.i-:,' ;.:.,: :.~.:' ...... .; _u
. ..:..... '.;_.-: .....
'.' .'. ;'~
'.:'-:,'.: ,".
!
L:::\I\UL:
~f
:W \ CD
rW1CQ[( COiWAlIY: J:to.~.JJ\_.~Q.0" N\~J';>L':::f: \-:-I.OI'J\E:. ,p'",e.:t::
lOCATlOil: SDc -ro17...:' 6:.\,IjL~llivJ M(l~>ll-e 0-crvlS t<.:::> !--/\O\Jf2,;:>\f-.\.
CITY
OF SPRIriGFl[LO SYSTGIS OEVELOP:lc,;;i
. \VORKSHEET'.
(CO/ll\mCI^l f. RESIOEHTI^L)
OEVELOrHEllT TYPE:
[JUIlOWG SIZE:
LOT SIZe
.SQ. Ft.
1. STORH ORMlI^GE
Il,:rERVIOUS SQ. n. x so. ISG PER SQ. FT, Is &
(See Re\'er~e For Rc:lr:lff Coefficients If f\ctu~l kpen. f\re~ I~ UnknO'o;n)
2. SAI:ITARY SEYER-CITY
r:o. 0:- rEV'S I Lj, . X 531:>.55 rCR r::L!
(See Rcver~e To O~tel~ine Tat~l rEV'S)
Is C;?~\ l~ I
~. . JX~:~r~..;j.~.:~I"~\ 1_!.G.;:.
t:r; cr- I~::!T: x T:~::' :~:\T;: X (CST rc~ TRI['
,__1___.. :':
l-.;I..:
--....- ---
~: s:::::: _ c:
\ .....,,.. _ :;.l '"" I
.~ I~~~ .;, - ~
. '!. j::-:::..fj 1
.,
:( ;:::j.G~
-----
'See A'-'c;'-~"''' L' '1'.- 111.'-""-;"" -....;... I:""I..,",,~,
\ 1"...... .....:........ v L,;:...L:,;.....d.'- t. ':-- .........--j
IT -""I. ".. -. '..J
SUGTOTAL '(1'\00 a:s I,Z. & 3) S ,,,,:--
4. AOlmnSTRI',TlVE FEES
'ni,SE CHARGE (SUBTOTAL ASOVE) X ;05
k '1;>'3':;" I
IC.-:-:..~.-::~~":
,--,-
.....
GI'"
r c.....,... ,'"
..........- -
5. SAtlITM1Y SEI.JErHfriIK,
. '..:..
,rlO. OF PFU'S
. r..J.
x 513.25 PER PFU .+ 5!O 1-I\.IHC mXIN. FEE S /4 t:; ~
.-~ .'-".
'.. ...-......
.. ..
, '
.' '." .
'.1. .
.. .~. .
- .--', -- .'-.
",',' ,"s ":'-'"
TOTAL -MIme S~C: Is 1"7 '? ~ I
TOTAL SOC ~ G. 't!:-
, ,;;;,,;':' .':'. .,~. ., K~'P 'Burdi ck
.._., ", SDC coordinator
...... .
..." .
~
-:-~.-'.-.-._' .......
.: ~ .
.. ".~ --..... ,.
... .,. .,
'6.s.qL-~~~
'.
. ..... .:':'~..,.. ':'.
. .- ~ ....
. .;.: .;..:..~":.:.:' ";, , -..
. .:.~.\ -;::::, .~.,
,....
..' '.':.,
.
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@ Y.!!W.1!!:!!!!~!!~
Job No.
q4fb95
SYSTEMS DEVELOPMENT CHARGE
ADDRESS ~f) Lf) ~CS~~ I TATEG\? zwihtJ3'
LOCATION OF filROPOSED BUIL9L,NG SI~ l j :it:j^C::-
Street Address if Known: (\ ) /5 u HY) 11A.Il--- L.J......:)
f\ \~ ~ T~ L~ "om"'" \ II 039- 'lj () o41CO
NAME:
Platt Name:
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
NO OF UNITS
Manufaoured home not in a park
X $400 PER UNIT _=
$
B. Single Familv - Attached
.
NO OF UNITS
X $370 PER UNIT =
, $
C. Multi-Familv Aoartment
NO OF UNITS
X $277 PER UNIT =
$
D. Manufaoured Home Park
NO OF UNITS
X $280 PER UNIT =
$dJ9D,dJ
$ ~M,CO
$p
$J2/) cD
left'
WPRD SDC
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See sac Credit Worksheet.
~:O~-J: ",IT SOC A~:;:J ,~~ ~,~;", n
Community Services DiviSiO~ Date
City of Springfield