HomeMy WebLinkAboutPermit Plumbing 1993-9-14
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JOB NUMBER Qolc3f)(o
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726'3759
LOCATION OF PROPOSED WORK:, ~ /.f=)){)
ASSESSORS MAP' 10 ()l~ ~1 I (
225 Fifth Street
Springfield, Oregon 97477
LOT'
BLOCt<'
TAX LOT' " [)tLt{X)
SUBDIVISION: JJDrlin. ,~.1
,
MECHANICA' . ,
.ELECTRICA~: ( , RI\\) ~~ ~ \"i\
QUAD AREA: -' . Q 1U 1 )
. OF ~LDGS" (
OCCY GROUP: ~H::)cj J..,L
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OWNER: P Len.n 'f)t'...J \( (l)n.J!\f\(1 PHONE:~51
ADDRE'''t 10 \?\ (\)" \. !(\f\(~1 '0 ) . , (
CITY: ""\\,)\J..~~ o]~" STATE: (\)~o ~fX0" ZIP: OJ\41\ I
DES~RIBnw~Rl. AN \r\ r\t L~ ' ~t"lrY\ Q . dy (\ f\Jl_)JQJ"j ~
NEW \.....LJ REMODEL ADDI 10 DEMOLISH OTHER'
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, CONST, IV
CONTRACTOR'S NA~E ~A ADDRESS C~'}IjRACTOR . EXPIRES AONI7J
GENERAL: (-:I~o(\-"-n\\ \\ \~ 7 '1441 Gt,\{ Y~/l~f (ddtV7 5Tq4 tp~-?J!oL
PLUMBING: ('~J'{o\o C\-tlo\ ~ ">> tsN\, fJ (ql~ ,f) ~
, Co-Sri] (Q .fYl ~3 ,94llSfi)
)
. OF STORIES:
- OFFICE USE-
LAND USE: _/ I S(j
I "
. OF UNITS:
CONSTR, TYPE: U,AJ
HEAT SOURCE: t- -f.'_
'7.-/
FLOOD PLAIN'
ZONING CODE:~
. OF BDRMS' ---;z;r-
,
,....
SECONDARY HEAT:
SQUARE FOOTAGE:.J&. q~ _
WATER HEATER:
RANGE:
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.
REQUIRED INSPECTIONS
o lemporary Electric o Rough Mechanical - Prior to o Final Plumbing '- When all
cover. plumbing work Is complete.
D Site Inspection - To be made ~ ~~:e~h~~~or to CfL Final Electrlca' - When all
after excavation, but prior to 'electrical w~mPle~
s~~lj."iS' ~. ,
~ Un,ders a Wmbln leclrl~ D Electrical Service - Must be D Final Mechanical - ~n all
Mechanical - Prlo ove. approved to obtai n permanent mechanical work Is complete.
electrical power.
o Footing - After trenches are ~nal Building - When all
excavated. o Fireplace - Prior to facing 'qui red Inspections have been
materials and framing Insp. approved aneKtg 'bvt;
o Masonry - Steel location, bond completed. p .
beams, grouting. o Framing - Prior to cover.
o Foundation - After forms are o Other
erected but prior to concrete o Wail/Ceiling Insulation - Prior to
placement. cover.
o Underground Plumbing - Prior o Drywall - Prior to taping,
to filling trench.
MOBILE HOME INSPECTIONS
o Underfloor Plumbing/Mechanical o Wood Stove - After I~stallatlon. ,
- Prior to Insulation or decking.
~... ~BIOCklng and Set.Up - When all
o Post' and Beam - Prior to floor o Insert - After fireplace approval blocking Is complete.
Insulation or decking.
\ and Installation of unit.
o Floor Insulation - Prior to ~IUmblng Connections - When
deoklng, o Curbcut & Approach - After orne has been connected to
forms are erected but prior to water and sewer.
~ Sanitary Sewer - Prior to filling placement of concrete.
trench. ~Iectrlca' Connection - When
o Sidewalk & Driveway - After locking, set.up, and plumbing
o Storm Sewer - Prior to filling excavation Is complete, forms . Inspections have been approved
trench. . . and sub.base material In place. and the home is connected to
I the service panel.
~ Water L1n~ ~ Prior ,~ filling ,0 Fence - When completed.
trench. ~nal - After all required
, Inspections are approved and
o Rough Plumbing - PrIor t~ o Street Trees - When all required porches, sklrling, decks, and
cove~ . trees are planted. . venting have been installed.
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Lot faces Lot Type Setbacks
Lot sq, ltg, 2\ Interior I PL. HSE GAR ACC I
'IN I
Lot coverage' Corner
Is I
Topography Panhandle
'Iw I
Total height Cul,de,sac
IE I I
BUILDING PERMIT
ITEM SO, FT, X $/SO, FT.
Main
Garage
Carport
I..
Total Value
, Building Permit Fee
State Surcharge
Total Fee
(A)
VALUE
t(),Q4~
M.W
r /U
~3.1{)
SYSTEMS DEVELOPMENT CHAR<5~DC1v'\
. (B) 3!Jt.o.-,U
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT,
FT,
Water
Storm Sewer
FT,
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsertlFlreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
I
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
FEE
Jl~ 0...)
~ ' c.fJ
ACQ ,
15.cr)~'
( 05 pJ
~~.d:)
t.P-r./J. ~
(LJ
/()5 .cfJ
cO()OO
....S-.r<l ~
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical) 19. \f()r;x.J
(A, B, C, D, and E Combined) 61fH lc6 ; C\l1Lo 1'[ )
tHE PROPOSED WORK IN 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.
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is grantl?d on t,he ~xpress conqlt~on, that the said
construction shall, In all ,respects, conform to the Ordinance
adopte.d by the City of Springfl~ld, ,inci'uding the
Development Code, regulating the cOnstruction and use of
buildings, and may be suspended or r~voked at any tl
upon violation of any. provisions of said ordlnanc
Plan Check Fee' )
Date Paid: _' \\:) ~ ~
Receipt Number' ~
R7
*"Plans Reviewed By
Date
Systems Development Charge Is due on all undeveloped
prop.erties within the City limits which ar.e 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 all
Information hereon Is true and correct, and I further certify
that any and all work performed shall be done In accordance
with the Ordinanc~s 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 GRS 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
*:"::9;;::':"~"
Date
VALIDATION: (\ I
RECEIPT NUMBP1JD9A, J* \C'f74 \
DATE PAin '-'\,. \4 .CL~'
AMOUNT REC~f~ .\0 (VJ:1lPX)Y.W1,70)
RECEIVED BY c~~\/:~lfi,--) - -
...-'.. ...
_00
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DEVELOPMENT SERVICES
ADMINISTRATION
PLANNING / BUILDING
PUBLIC WORKS
METROPOLITAN WASTEWATER MANAGEMENT
225 FIFTH STREET
SPRINGFIELD, OR 97477
(503) 726.3753
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 vith
the,i}~rOva~ the attached ~er~ts for a home to be located at
0//00 aLLA/2 ." -:/:f r::J I,-J , Springfield, Oregon, Ci ty Job Number
L{.:3/~..J,?-"I i wl11 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 sidel.'alk
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 belov, that I have been provided vith the
folloving information,
Manufactured Home Blocking Requirements
Minimum Requirements for Permanent Steps
- Electrical Connection
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CITY
OF .RIlIGFltlD SYSTH1S OEVElOP..lIll,;,iH
WORKSHEET ·
(Cot111ERCIAL (, RESIDENTIAL)
CllliHGE
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NN1[ Oft COI'll'MIY: J:to.~J"-':,._,bQ.0" N\.9J'::>l':::f'-- ~o"M;.' p^~
LOCATIOtl: SD(, -;-;; '\'7~ P,.\)~1Bv~ ~P.'IL-lC. U-cMS I';> ty\o\J!2-';>\;--\,
DEVELOPMENT TYPE:
[JUILDING SIZE:
,LOT S lIE'
SQ. Ft.
1, STOR!" ORA BIAGE
IHPERVIOUS SQ. Fr. . X SO.18G rER SQ. FT.
(See Reverse For Runoff Coefficients If Actual I~perv. Area
Is C-
Is UnknO'.m)
z. Std:lTA!~Y SE>if:!~-C!TY
r:o, 0:: PFU'S I Lj. X S38.55 P[:( r::v
(See Reverse To O,~ten:linc Total rEU'S)
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utJ Gr: UU!T~ X 1~~~-:1 :U'JE X (CST r[~. TRI1)
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(See ^tt::!.cli:::C:1~ L To u~tcr::1nQ Trip KJ.t.C::;)
SUGTOTAl"(ADD ITEi':S 1,2, &. 3) S
4. AOIHIHSTRATIVE FEES
"lli,SE, CHARGE (SUBTOTAL ABOVE) X ;05
h '1;>'01:::- I
TOT:\~_-CIi',' S~:;:.
r C.-I' 9.0
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S. SANITARY SEWER-H\.JI'IC
: 110. OF PFU'S
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x 513.25 PER PFU .+ S!D MWHC ADMIN. FEE ~ /4 c:; ~
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" ;,:,':;~::>}~(~~~ PFU T~tal F~~~j~~,~i~~ove)'
'. NWHC '~"REDIT- IF-^PPliaBl..E(SE~REVERSE)
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";;~,,:,:, ~ .Kip Burdick.
" _,_ SOC Coordinator
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TOTAL-M~~CSD~ Is I~C;~ I
TOTAL soc 1i qq ~ f!...
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job No. q3t~(p
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAt,1{J't'0\\-~ ~(l ~ f]tf,D PHONE: n4/7-Rq~jl
ADDRESS: rO I of) ~(P J J Jl fu \~,b. STATE: Br ZIP !I!l40 1
LOCATION OF PROPOSED '1Y1~DING SIT~() / . J/. '
Street Address if Known:d lOr) \,'}.A j j Jl ~ \. 1h. c!J /." 5
Platt Name: n 1r\J Tax Lot Number: I f]LY3~'lJa rJ11cD
I
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
_ 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 =
$ dPC') 00
$dw)oO
$ Qf
$/J >::D.Oc)
WPRD SDC
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)
~~,,~!~~Qf) D~ I
City of Springfield
14 / Cl3.~~
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